Provider Demographics
NPI:1750441366
Name:WEIERMAN, MARY E (MHP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WEIERMAN
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8743 S KOLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HOMETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:60456
Mailing Address - Country:US
Mailing Address - Phone:708-346-0463
Mailing Address - Fax:
Practice Address - Street 1:6415 STANLEY
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-788-0511
Practice Address - Fax:708-788-0831
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator