| Doctor Name: | DR. ALICE R. WIEDENHOFF |
| NPI Number: | 1053524082 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 17454 |
| Business Practice Address: | North County Child Study Center, 6949 El Camino Real Ste. 201 Carlsbad, CA - 920094140 |
| Business Phone Number: | 7696037770 |
| Business Fax Number: | 7606037753 |
| Mailing Address: | North County Child Study Center, 6949 El Camino Real, Ste. 201 CARLSBAD |
| State: | CA |
| Postal Code: | 920094140 |
| Phone Number: | 7696037770 |
| Fax Number: | 7606037753 |
| NPI Enumeration Date: | 05/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 17454 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |