Individual
JOHN R WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2717 N GRANDVIEW BLVD, #303, WAUKESHA, WI 53188
(262) 544-6486
(262) 544-6377
Mailing address
525W26295 MACARTHUR RD, WAUKESHA, WI 53188
(262) 542-0163
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1969057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39137400
—
WI
Enumeration date
10/12/2006
Last updated
07/08/2007
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