Basic Information
| Provider Information | |||||||||
| NPI: | 1780627133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | JEANNIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MSW, CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 ORLEANS BLVD | ||||||||
| Address2: | |||||||||
| City: | COLDWATER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490361767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172798404 | ||||||||
| FaxNumber: | 5172798172 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 ORLEANS BLVD | ||||||||
| Address2: | |||||||||
| City: | COLDWATER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490361767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172798404 | ||||||||
| FaxNumber: | 5172798172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801078112 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.