Provider Demographics
NPI:1477604056
Name:WIESER, JOANNE I (MA)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:I
Last Name:WIESER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:411 N. 3RD. ST. SUITE A3
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541
Mailing Address - Country:US
Mailing Address - Phone:360-861-8184
Mailing Address - Fax:360-482-3527
Practice Address - Street 1:411 N. 3RD ST.
Practice Address - Street 2:SUITE A3
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-861-8184
Practice Address - Fax:360-482-3527
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000130101YA0400X
WARC00021305101YM0800X
WALF00002627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist