Individual
JORDAN LEWIS WIEDERSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1506 BEXAR CROSSING ST, SAN ANTONIO, TX 78232-1587
(210) 208-5633
(210) 832-5005
Mailing address
1506 BEXAR CROSSING ST, SAN ANTONIO, TX 78232-1587
(210) 208-5633
(210) 832-5005
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
64300
TX
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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