Provider Demographics
NPI:1275607731
Name:WIEMAN, JOEL B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:WIEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W 9TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3219
Mailing Address - Country:US
Mailing Address - Phone:907-276-7374
Mailing Address - Fax:907-276-8316
Practice Address - Street 1:1345 W 9TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3219
Practice Address - Country:US
Practice Address - Phone:907-276-7374
Practice Address - Fax:907-276-8316
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical