Individual
MS. JOANNA ELISE WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7581
Mailing address
9169 W STATE ST STE 725, BOISE, ID 83714-1733
(208) 828-7581
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
203430
ID
Other
Enumeration date
03/18/2011
Last updated
10/16/2025
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