Provider Demographics
NPI:1780815043
Name:WIEBE, JACQUELINE BABBS (PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BABBS
Last Name:WIEBE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:BABBS
Other - Last Name:FINKBONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2301 MARSH LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8497
Mailing Address - Country:US
Mailing Address - Phone:972-428-1652
Mailing Address - Fax:972-428-1652
Practice Address - Street 1:2301 MARSH LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8497
Practice Address - Country:US
Practice Address - Phone:972-428-1652
Practice Address - Fax:972-428-1606
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24726103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist