| Doctor Name: | MRS. SYD L WIESEL |
| NPI Number: | 1669479820 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 1866 LCSW |
| Business Practice Address: | 390 1st St Sw Bandon, OR - 974119667 |
| Business Phone Number: | 5413471134 |
| Business Fax Number: | 5413471134 |
| Mailing Address: | Po Box 1844, BANDON |
| State: | OR |
| Postal Code: | 974111844 |
| Phone Number: | 5413471134 |
| Fax Number: | 5413471134 |
| NPI Enumeration Date: | 07/02/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 1866 LCSW |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |