| Doctor Name: | JESSICA M WIENER |
| NPI Number: | 1205236593 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PC |
| License Number: | C.1300702 |
| Business Practice Address: | 34950 Chardon Rd Ste 202 Willoughby Hills, OH - 440949162 |
| Business Phone Number: | 4405105100 |
| Business Fax Number: | 4405105151 |
| Mailing Address: | 37658 Lake Shore Blvd Unit 1, EASTLAKE |
| State: | OH |
| Postal Code: | 440951048 |
| Phone Number: | 4404795145 |
| Fax Number: | |
| NPI Enumeration Date: | 08/25/2014 |
| NPI Last Update Date: | 08/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | C.1300702 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |