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NPI Code Detail

MEDICARE: MRS. SHANNON KATHLEEN WIEDENMAN

MEDICARE: MRS. SHANNON KATHLEEN WIEDENMAN
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
1104100000XSocial Worker213356MA

General Provider Information

NPI Number : 1649384215
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON KATHLEEN WIEDENMAN
Provider Business Mailing Address
First Line : 7 WYATT ST
Second Line :
City : SOMERVILLE
State : MA
Zip : 02143-3917
Country : US
Telephone Number : 671-767-1834
Fax Number :
Provider Business Practice Location Address
First Line : 301 BROADWAY
Second Line :
City : CHELSEA
State : MA
Zip : 02150-2807
Country : US
Telephone Number : 617-912-7972
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. SHANNON KATHLEEN WIEDENMAN ” Practice Location

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