Provider Demographics
NPI:1114910973
Name:WEIDLING, JOAN ESTREM (LMFT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ESTREM
Last Name:WEIDLING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:R
Other - Last Name:ESTREM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:7575 GOLDEN VALLEY RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4562
Mailing Address - Country:US
Mailing Address - Phone:763-525-8590
Mailing Address - Fax:763-525-8592
Practice Address - Street 1:7575 GOLDEN VALLEY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4562
Practice Address - Country:US
Practice Address - Phone:763-525-8590
Practice Address - Fax:763-525-8592
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1072103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN467432400Medicaid