| NPI | 1184823239 |
|---|---|
| Former Name | JUDY KAYE WIEBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 002100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 001621) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2019-09-27 |