Individual
MRS. SHANNON KATHLEEN WIEDENMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 BROADWAY, CHELSEA, MA 02150-2807
(617) 912-7972
Mailing address
7 WYATT ST, SOMERVILLE, MA 02143-3917
(671) 767-1834
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
213356
MA
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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