Provider Demographics
NPI:1821246497
Name:WEIGLE, KAREN L (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:WEIGLE
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 1:1000 E 3RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2106
Mailing Address - Country:US
Mailing Address - Phone:423-622-0500
Mailing Address - Fax:423-622-0564
Practice Address - Street 1:1000 E 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2106
Practice Address - Country:US
Practice Address - Phone:423-622-0500
Practice Address - Fax:423-622-0564
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2774103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509957Medicaid
TN1509957Medicaid