Weaver, John R

Weaver, John R is an individual health care provider with primary practice located at 2717 N Grandview Blvd #303, Waukesha WI 53188. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Weaver, John R can be contacted via phone (262) 544-6486.

Contact Information

Primary practice address
2717 N Grandview Blvd #303 Waukesha WI 53188
Fax: (262) 544-6377
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1969057 Wisconsin

Profile Details

NPI number 1376632893
LBN Legal business name Weaver, John R
Credentials PSYD
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376632893 NPPES
Wisconsin MEDICAID 39137400

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