Provider Demographics
NPI:1811199722
Name:WIEAND, LOU ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOU
Middle Name:ANN
Last Name:WIEAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 GOUGH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4415
Mailing Address - Country:US
Mailing Address - Phone:707-499-2849
Mailing Address - Fax:
Practice Address - Street 1:425 GOUGH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4415
Practice Address - Country:US
Practice Address - Phone:415-529-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11080103T00000X
CAPSY 11080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist