Provider Demographics
NPI:1295879864
Name:WECKER, MARYJO -
Entity type:Individual
Prefix:MS
First Name:MARYJO
Middle Name:-
Last Name:WECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARYJO
Other - Middle Name:-
Other - Last Name:HOHSTADT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4715 OAKLEAF CT NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-3389
Mailing Address - Country:US
Mailing Address - Phone:503-463-1148
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE
Practice Address - Street 2:SUITE 530
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1882
Practice Address - Country:US
Practice Address - Phone:503-881-8250
Practice Address - Fax:503-393-3135
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor