MEDICARE: CATHLEEN LYNN WEIDNER MSW

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	1041C0700X	Clinical Social Worker	14739	TX

General Provider Information

NPI Number	:	1962684472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHLEEN LYNN WEIDNER MSW

Provider Business Mailing Address
First Line	:	6073 THE RESORT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-6632
Country	:	US
Telephone Number	:	214-707-4148
Fax Number	:

Provider Business Practice Location Address
First Line	:	6073 THE RESORT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-6632
Country	:	US
Telephone Number	:	214-707-4148
Fax Number	:

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

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	05/31/2022

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