Provider Demographics
NPI:1063413284
Name:WARREN WEIL, CLARICE LOUISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLARICE
Middle Name:LOUISE
Last Name:WARREN WEIL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 KNOLLS CT
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2741
Mailing Address - Country:US
Mailing Address - Phone:515-267-8098
Mailing Address - Fax:515-221-3183
Practice Address - Street 1:764 KNOLLS CT
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2741
Practice Address - Country:US
Practice Address - Phone:515-267-8098
Practice Address - Fax:515-221-3183
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5661900000Medicaid