Provider Demographics
NPI:1841490182
Name:WIERMANSKI, MARY ANN (MA BCBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WIERMANSKI
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39667 N WARREN LANE
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60083-3051
Mailing Address - Country:US
Mailing Address - Phone:847-336-4823
Mailing Address - Fax:847-249-9701
Practice Address - Street 1:39667 N WARREN LANE
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60083-3051
Practice Address - Country:US
Practice Address - Phone:847-336-4823
Practice Address - Fax:847-249-9701
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist