Doctor Name: | DR. TIMOTHY C. WIEDEL |
NPI Number: | 1033208319 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 1227-057 |
Business Practice Address: | 7251 W North Ave Suite 5 Wauwatosa, WI - 532131851 |
Business Phone Number: | 4142482554 |
Business Fax Number: | 4143024620 |
Mailing Address: | 7251 W North Ave, Suite 5 WAUWATOSA |
State: | WI |
Postal Code: | 532131851 |
Phone Number: | 4142482554 |
Fax Number: | 4143024620 |
NPI Enumeration Date: | 10/12/2006 |
NPI Last Update Date: | 01/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 1227-057 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |