| Doctor Name: | MARK WIEZOREK |
| NPI Number: | 1578946703 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSAT, TLMHC |
| License Number: | 076987 |
| Business Practice Address: | 209 W Main St Anamosa, IA - 522051811 |
| Business Phone Number: | 3197742045 |
| Business Fax Number: | |
| Mailing Address: | 209 W Main St, ANAMOSA |
| State: | IA |
| Postal Code: | 522051811 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/07/2015 |
| NPI Last Update Date: | 07/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 076987 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |