Provider Demographics
NPI:1063680957
Name:WISER, DEBORAH ANN
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:WISER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12882 MANCHESTER ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-863-9912
Mailing Address - Fax:314-863-9918
Practice Address - Street 1:12882 MANCHESTER ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-863-9912
Practice Address - Fax:314-863-9918
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical