Provider Demographics
NPI:1932156718
Name:WEISSER, CHARLES E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:WEISSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 OFFICERS ROW
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3845
Mailing Address - Country:US
Mailing Address - Phone:360-993-2939
Mailing Address - Fax:360-993-1060
Practice Address - Street 1:754 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3845
Practice Address - Country:US
Practice Address - Phone:360-993-2939
Practice Address - Fax:360-993-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1409103TC0700X
OR1104103TC0700X
WAPY00001409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB11260Medicare UPIN
AB11260Medicare ID - Type Unspecified