Provider Demographics
NPI:1235710948
Name:WIANT, MANDIE LEIGH
Entity Type:Individual
Prefix:
First Name:MANDIE
Middle Name:LEIGH
Last Name:WIANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3020
Mailing Address - Country:US
Mailing Address - Phone:719-470-0320
Mailing Address - Fax:
Practice Address - Street 1:8201 S CROW CUTOFF
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-9704
Practice Address - Country:US
Practice Address - Phone:719-568-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor