Individual
JACQUELINE ANN WEYDERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
200 4TH AVE W, GRINNELL, IA 50112-1833
(641) 236-6137
Mailing address
200 4TH AVE W, GRINNELL, IA 50112-1833
(641) 236-6137
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
06609
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871752436
—
IA
Enumeration date
06/08/2008
Last updated
11/25/2008
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