Provider Demographics
NPI:1194544775
Name:WEHDE, ANNA THERESE (PHD, LP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:THERESE
Last Name:WEHDE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MAIN ST UNIT 2D
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3375
Mailing Address - Country:US
Mailing Address - Phone:860-248-6046
Mailing Address - Fax:
Practice Address - Street 1:360 MAIN ST UNIT 2D
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3375
Practice Address - Country:US
Practice Address - Phone:860-248-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4904103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist