| Doctor Name: | MS. TERESA WIEDEMANN |
| NPI Number: | 1063790509 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | LW 60111377 |
| Business Practice Address: | 139 Russet Rd Walla Walla, WA - 993628253 |
| Business Phone Number: | 5095204370 |
| Business Fax Number: | |
| Mailing Address: | 139 Russet Rd, WALLA WALLA |
| State: | WA |
| Postal Code: | 993628253 |
| Phone Number: | 5095204370 |
| Fax Number: | |
| NPI Enumeration Date: | 08/02/2011 |
| NPI Last Update Date: | 04/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LW 60111377 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |