Provider Demographics
NPI:1841242294
Name:WEIS, JO M (PHD)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:M
Last Name:WEIS
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:BEHAVIORAL HEALTH CLINIC @ TOSA
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3421
Mailing Address - Country:US
Mailing Address - Phone:414-955-8900
Mailing Address - Fax:414-955-6285
Practice Address - Street 1:1155 NORTH MAYFAIR ROAD
Practice Address - Street 2:BEHAVIORAL HEALTH CLINIC @ TOSA
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-955-8900
Practice Address - Fax:414-955-6285
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2245103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841242294Medicaid
004006261JOtherHUMANA
WI1841242294Medicaid
P05490Medicare UPIN