| Doctor Name: | MRS. JOANNE I WIESER |
| NPI Number: | 1477604056 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | CP00000130 |
| Business Practice Address: | 411 N. 3rd St. Suite A3 Elma, WA - 98541 |
| Business Phone Number: | 3608618184 |
| Business Fax Number: | 3604823527 |
| Mailing Address: | Po Box 133, 411 N. 3rd. St. Suite A3 ELMA |
| State: | WA |
| Postal Code: | 98541 |
| Phone Number: | 3608618184 |
| Fax Number: | 3604823527 |
| NPI Enumeration Date: | 01/12/2007 |
| NPI Last Update Date: | 11/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CP00000130 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |