Provider Demographics
NPI:1659484780
Name:WESTHUIS, WESLEY ROSS
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:ROSS
Last Name:WESTHUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2533
Mailing Address - Country:US
Mailing Address - Phone:518-374-3514
Mailing Address - Fax:518-374-9193
Practice Address - Street 1:220 N BALLSTON AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2533
Practice Address - Country:US
Practice Address - Phone:518-374-3514
Practice Address - Fax:518-374-9193
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018795-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52171EMedicare ID - Type Unspecified