Provider Demographics
NPI:1780619353
Name:WIEBEL, GARY LEE JR (MSW)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:WIEBEL
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 16TH AVE APT 426
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5277
Mailing Address - Country:US
Mailing Address - Phone:907-278-1966
Mailing Address - Fax:
Practice Address - Street 1:201 E 16TH AVE APT 426
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5277
Practice Address - Country:US
Practice Address - Phone:907-278-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker