Provider Demographics
NPI:1417038530
Name:WEIGAND, KENNETH GEORGE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GEORGE
Last Name:WEIGAND
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E 1260 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7501
Mailing Address - Country:US
Mailing Address - Phone:435-750-6300
Mailing Address - Fax:435-753-8995
Practice Address - Street 1:246 E 1260 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7501
Practice Address - Country:US
Practice Address - Phone:435-750-6300
Practice Address - Fax:435-753-8995
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA277255000OtherMAGELLAN
VA107671OtherANTHEM