Provider Demographics
NPI:1447610548
Name:WIEBE, KATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:WIEBE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 GEARY BLVD
Mailing Address - Street 2:159
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2112
Mailing Address - Country:US
Mailing Address - Phone:415-251-0276
Mailing Address - Fax:
Practice Address - Street 1:5758 GEARY BLVD
Practice Address - Street 2:159
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2112
Practice Address - Country:US
Practice Address - Phone:415-251-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist