Provider Demographics
NPI:1669180865
Name:WEIL, DESTINEE NICOLE
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:NICOLE
Last Name:WEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINEE
Other - Middle Name:NICOLE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3510 N 9TH ST LOT 3
Mailing Address - Street 2:
Mailing Address - City:CARTER LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51510-1347
Mailing Address - Country:US
Mailing Address - Phone:402-237-5940
Mailing Address - Fax:
Practice Address - Street 1:14301 FNB PKWY STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-7200
Practice Address - Country:US
Practice Address - Phone:402-807-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst