Provider Demographics
NPI:1780627133
Name:WEBER, JEANNIE MARIE (MSW, CSW)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARIE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ORLEANS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1767
Mailing Address - Country:US
Mailing Address - Phone:517-279-8404
Mailing Address - Fax:517-279-8172
Practice Address - Street 1:200 ORLEANS BLVD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1767
Practice Address - Country:US
Practice Address - Phone:517-279-8404
Practice Address - Fax:517-279-8172
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010781121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP20060002Medicare ID - Type Unspecified