Individual
MRS. MAUREEN L WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.PED
Contact information
Practice address
11211 SE 82ND, AVE, STE. D, PORTLAND, OR 97086
(503) 653-8700
(503) 653-8739
Mailing address
11211 SE 82ND, AVE, STE. D, PORTLAND, OR 97266
(503) 653-8700
(503) 653-8739
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
229276
—
OR
Enumeration date
12/14/2006
Last updated
09/26/2024
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