Provider Demographics
NPI:1639900491
Name:WEATHERWAX, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WEATHERWAX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 DELTA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2032
Mailing Address - Country:US
Mailing Address - Phone:513-389-6919
Mailing Address - Fax:
Practice Address - Street 1:559 DELTA AVE APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-2032
Practice Address - Country:US
Practice Address - Phone:513-389-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst