Provider Demographics
NPI:1710356076
Name:WEITERING, MARY KATHARINE (LABA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHARINE
Last Name:WEITERING
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHARINE
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5150 VILLAGE PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6652
Mailing Address - Country:US
Mailing Address - Phone:425-657-0620
Mailing Address - Fax:425-502-8425
Practice Address - Street 1:5150 VILLAGE PARK DR SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6652
Practice Address - Country:US
Practice Address - Phone:425-657-0620
Practice Address - Fax:425-502-8425
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst