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Individual

DUDLEY JAY WIEST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
1110 E CHAPMAN AVE STE 202, ORANGE, CA 92866-2139
(714) 744-9754
Mailing address
3345 E COPPER KETTLE WAY, ORANGE, CA 92867-2057
(714) 273-9591

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
14883
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14883
LICENSE NUMBER
CA
Enumeration date
06/20/2022
Last updated
06/20/2022
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