Provider Demographics
NPI:1407214430
Name:WIEDA, JILLIAN C (MSC)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:C
Last Name:WIEDA
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10237 N BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-4512
Mailing Address - Country:US
Mailing Address - Phone:559-930-5462
Mailing Address - Fax:
Practice Address - Street 1:4440 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-2304
Practice Address - Country:US
Practice Address - Phone:559-225-1102
Practice Address - Fax:559-375-7164
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor