Provider Demographics
NPI:1114506938
Name:WIERMAN, REBECCA ANN (MA, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:WIERMAN
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WALLS DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5180
Mailing Address - Country:US
Mailing Address - Phone:203-689-8989
Mailing Address - Fax:
Practice Address - Street 1:511 28TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4161
Practice Address - Country:US
Practice Address - Phone:801-655-5450
Practice Address - Fax:385-225-9327
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14196333-6004101YM0800X
WALH61550983101YM0800X
ID2571036101YP2500X
COLPC-0017055101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional