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NPI Code Detail

MEDICARE: CYNTHIA A WIEDEMANN

MEDICARE: CYNTHIA A WIEDEMANN
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
1106H00000XMarriage & Family TherapistMFC 28811CA

General Provider Information

NPI Number : 1982729554
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA A WIEDEMANN
Provider Business Mailing Address
First Line : 304 MENDOCINO DR
Second Line :
City : UKIAH
State : CA
Zip : 95482-5319
Country : US
Telephone Number : 303-447-2569
Fax Number :
Provider Business Practice Location Address
First Line : 6150 ORR SPRINGS RD
Second Line :
City : UKIAH
State : CA
Zip : 95482-9032
Country : US
Telephone Number : 707-462-5056
Fax Number : 707-462-5205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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Directions to “ CYNTHIA A WIEDEMANN ” Practice Location

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