Provider Demographics
NPI:1659360154
Name:WIEGERS, REBECCA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:WIEGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3825 NORTHERN PIKE
Mailing Address - Street 2:STE 202
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2161
Mailing Address - Country:US
Mailing Address - Phone:412-980-7325
Mailing Address - Fax:412-247-1037
Practice Address - Street 1:3825 NORTHERN PIKE
Practice Address - Street 2:STE 202
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2161
Practice Address - Country:US
Practice Address - Phone:412-480-7325
Practice Address - Fax:412-373-7324
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002777L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
163887OtherVALUE OPTIONS
PA204748OtherUPMC
PA2062936OtherCIGNA
PA547860OtherBCBS
PA001738510Medicaid
PA001738510Medicaid
PA107409Medicare ID - Type Unspecified