Provider Demographics
NPI:1093736845
Name:WEIDMAN, EMMALINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMMALINE
Middle Name:
Last Name:WEIDMAN
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 1:18611 CLIPPERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9711
Mailing Address - Country:US
Mailing Address - Phone:231-547-7323
Mailing Address - Fax:231-547-7327
Practice Address - Street 1:18611 CLIPPERVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9711
Practice Address - Country:US
Practice Address - Phone:231-547-7323
Practice Address - Fax:231-547-7327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5585230OtherAETNA
MI62OF34852OtherBLUECROSS BLUESHIELD
MI55410-72564OtherU.S. BEHAVIORAL HEALTH
MI1055752OtherCIGNA BEHAVIORAL HEALTH
MI046482OtherVALUE OPTIONS
MI140447OtherCARE CHOICE
MI207174OtherMHN
MI58894OtherPPOM
MII.P.046056OtherMAGELLAN
MI136230OtherCOMPSYCH
MII.P.046056OtherMAGELLAN
MI62OF34852OtherBLUECROSS BLUESHIELD