Individual
DR. PAUL ROBERT WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1116 N CHIPMAN ST, OWOSSO, MI 48867-4901
(906) 362-7726
(989) 472-4110
Mailing address
1116 N CHIPMAN ST, OWOSSO, MI 48867-4901
(906) 362-7726
(989) 472-4110
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
FL EXEMPT 490.014
FL
103T00000X
Psychologist
Primary
6301008035
MI
103T00000X
Psychologist
673
WV
Other
Enumeration date
06/12/2013
Last updated
01/31/2014
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