Provider Demographics
NPI:1831435809
Name:WEIR, GERALDINE RICHELL
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:RICHELL
Last Name:WEIR
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 1:10050 E KIRSCH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JACOB
Mailing Address - State:IL
Mailing Address - Zip Code:62281-2128
Mailing Address - Country:US
Mailing Address - Phone:618-531-1871
Mailing Address - Fax:
Practice Address - Street 1:10050 E KIRSCH RD
Practice Address - Street 2:
Practice Address - City:SAINT JACOB
Practice Address - State:IL
Practice Address - Zip Code:62281-2128
Practice Address - Country:US
Practice Address - Phone:618-531-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist