Provider Demographics
NPI:1215375464
Name:WEIDINGER, DEBRA ROSE (BS)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ROSE
Last Name:WEIDINGER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 KATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2617
Mailing Address - Country:US
Mailing Address - Phone:313-587-0435
Mailing Address - Fax:
Practice Address - Street 1:4427 KATHERINE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2617
Practice Address - Country:US
Practice Address - Phone:313-587-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker