| Doctor Name: | MRS. KATHRYN JO WEAVER |
| NPI Number: | 1114243342 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW & LAT |
| License Number: | LAT-305 |
| Business Practice Address: | 157 N Coronado Dr Ste B Sierra Vista, AZ - 856356361 |
| Business Phone Number: | 5203432940 |
| Business Fax Number: | |
| Mailing Address: | 500 Hovland St, BISBEE |
| State: | AZ |
| Postal Code: | 856031322 |
| Phone Number: | 3077527678 |
| Fax Number: | |
| NPI Enumeration Date: | 04/13/2010 |
| NPI Last Update Date: | 12/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LAT-305 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |