Provider Demographics
NPI:1972651511
Name:WEISMILLER, MARIAN ROSE (M'ED)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:ROSE
Last Name:WEISMILLER
Suffix:
Gender:F
Credentials:M'ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PIPER HILL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1620
Mailing Address - Country:US
Mailing Address - Phone:314-995-1284
Mailing Address - Fax:
Practice Address - Street 1:115 PIPER HILL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1620
Practice Address - Country:US
Practice Address - Phone:314-995-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional