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NPI Code Detail

MEDICARE: MARY MACKENZIE WEIGERT BS

MEDICARE: MARY MACKENZIE WEIGERT BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1447863477
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY MACKENZIE WEIGERT BS
Provider Business Mailing Address
First Line : 601 NOBLE DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5544
Country : US
Telephone Number : 260-420-9332
Fax Number :
Provider Business Practice Location Address
First Line : 601 NOBLE DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5544
Country : US
Telephone Number : 260-420-9332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2020
Last Update Date : 08/05/2025

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