Provider Demographics
NPI:1891824611
Name:WIENEKE, MARY H (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:WIENEKE
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 1:823 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5539
Mailing Address - Country:US
Mailing Address - Phone:206-940-8861
Mailing Address - Fax:
Practice Address - Street 1:823 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5539
Practice Address - Country:US
Practice Address - Phone:206-940-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 3127103TC0700X
CAPSY 13834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical