Provider Demographics
NPI:1891827739
Name:WIEMEYER, JANICE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:K
Last Name:WIEMEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:K
Other - Last Name:SARGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1587
Mailing Address - Country:US
Mailing Address - Phone:360-376-4346
Mailing Address - Fax:
Practice Address - Street 1:109 NORTH BEACH ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-1587
Practice Address - Country:US
Practice Address - Phone:360-376-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2221103TC0700X
UT107649-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB11029Medicare ID - Type Unspecified