Doctor Name: | MR. ROBERT MOUW WIERSMA |
NPI Number: | 1366748949 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 001367 |
Business Practice Address: | 1022 3rd Ave Sheldon, IA - 512011561 |
Business Phone Number: | 7123248385 |
Business Fax Number: | |
Mailing Address: | 1022 3rd Ave, SHELDON |
State: | IA |
Postal Code: | 512011561 |
Phone Number: | 7123248385 |
Fax Number: | |
NPI Enumeration Date: | 01/31/2011 |
NPI Last Update Date: | 01/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 001367 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |