Provider Demographics
NPI:1275061814
Name:WIETIES, CALEY
Entity Type:Individual
Prefix:
First Name:CALEY
Middle Name:
Last Name:WIETIES
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 1:5621 N WAYNE AVE APT D1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4257
Mailing Address - Country:US
Mailing Address - Phone:281-844-0336
Mailing Address - Fax:
Practice Address - Street 1:906 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3608
Practice Address - Country:US
Practice Address - Phone:847-492-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)