Individual
MRS. SAMANTHA NICOLE WIEGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S., M.S.
Contact information
Practice address
707 N SMILEY ST, O FALLON, IL 62269-1353
(618) 632-6391
Mailing address
4826 RED OAK DR, WATERLOO, IL 62298-3068
(618) 540-4135
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2379352
IL
Other
Enumeration date
08/24/2022
Last updated
08/24/2022
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