Provider Demographics
NPI:1255007290
Name:WEISSSCHUH, JUERGEN
Entity Type:Individual
Prefix:
First Name:JUERGEN
Middle Name:
Last Name:WEISSSCHUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HICKORY ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1724
Mailing Address - Country:US
Mailing Address - Phone:541-760-2197
Mailing Address - Fax:833-224-3845
Practice Address - Street 1:110 HICKORY ST NW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1724
Practice Address - Country:US
Practice Address - Phone:541-760-2197
Practice Address - Fax:833-224-3845
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health