Provider Demographics
NPI:1083776819
Name:WEGMANN, MARY FRANCES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FRANCES
Last Name:WEGMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 S PEABODY ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6244
Mailing Address - Country:US
Mailing Address - Phone:360-457-1610
Mailing Address - Fax:360-457-5680
Practice Address - Street 1:618 S PEABODY ST
Practice Address - Street 2:SUITE F
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6244
Practice Address - Country:US
Practice Address - Phone:360-457-1610
Practice Address - Fax:360-457-5680
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA # 1710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical