Individual
DR. TIMOTHY C. WIEDEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
7251 W NORTH AVE, SUITE 5, WAUWATOSA, WI 53213-1851
(414) 248-2554
(414) 302-4620
Mailing address
7251 W NORTH AVE, SUITE 5, WAUWATOSA, WI 53213-1851
(414) 248-2554
(414) 302-4620
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1227-057
WI
103TC0700X
Clinical Psychologist
Primary
1227-057
WI
103TM1800X
Intellectual & Developmental Disabilities Psychologist
1227-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39071000
—
WI
Enumeration date
10/12/2006
Last updated
01/20/2012
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