MEDICARE: DR. KRISTIN MARY WEGNER PHD

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
1	103TC0700X	Clinical Psychologist	2675-057	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619125093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN MARY WEGNER PHD

Provider Business Mailing Address
First Line	:	1802 WARDEN ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-4960
Country	:	US
Telephone Number	:	715-552-1620
Fax Number	:	715-552-2734

Provider Business Practice Location Address
First Line	:	1802 WARDEN ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-4960
Country	:	US
Telephone Number	:	715-552-1620
Fax Number	:	715-552-2734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	02/12/2026

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