Doctor Name: | LISA E. WIENS |
NPI Number: | 1255544706 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D.,LP |
License Number: | LP4182 |
Business Practice Address: | 1404 Highway 71 International Falls, MN - 566492154 |
Business Phone Number: | 2182833406 |
Business Fax Number: | |
Mailing Address: | 1404 Highway 71, INTERNATIONAL FALLS |
State: | MN |
Postal Code: | 566492154 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LP4182 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |