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Individual

MRS. ELLEN H WEILAND

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.C.S.W.

Contact information

Practice address
132 W MAIN ST, MEDFORD, OR 97501-2746
(541) 326-8989
Mailing address
PO BOX 851, PHOENIX, OR 97535-0851
(541) 326-8989

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2150
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
181580
OR
01
317191
PBH
OR
01
858186000
BC BS - L.C.S.W.
OR
01
99945
JACKSON COUNTY MENTAL HEA
OR
01
J6586
PACIFIC SOURCE HEALTH PN
OR
Enumeration date
07/07/2005
Last updated
10/21/2009
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