Provider Demographics
NPI:1972977007
Name:WEIDLER, JESSE (MAT, BSL, BS)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:WEIDLER
Suffix:
Gender:M
Credentials:MAT, BSL, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-2931
Mailing Address - Country:US
Mailing Address - Phone:610-223-8553
Mailing Address - Fax:
Practice Address - Street 1:243 LINDEN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-2931
Practice Address - Country:US
Practice Address - Phone:610-223-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002928251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health