Provider Demographics
NPI:1235123910
Name:JANE F WEILENMAN, PHD, LLC
Entity Type:Organization
Organization Name:JANE F WEILENMAN, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WEILENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-667-7716
Mailing Address - Street 1:400 JOHNNY MERCER BLVD
Mailing Address - Street 2:P O BOX 30633
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2166
Mailing Address - Country:US
Mailing Address - Phone:912-667-7716
Mailing Address - Fax:
Practice Address - Street 1:400 JOHNNY MERCER BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2144
Practice Address - Country:US
Practice Address - Phone:912-667-7716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00951673AMedicaid