Provider Demographics
NPI:1316658339
Name:WEAVER, CORISSA A
Entity type:Individual
Prefix:
First Name:CORISSA
Middle Name:A
Last Name:WEAVER
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 1:905 MAIN ST STE 409
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6064
Mailing Address - Country:US
Mailing Address - Phone:541-887-2344
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN ST STE 409
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6064
Practice Address - Country:US
Practice Address - Phone:541-887-2344
Practice Address - Fax:541-887-2291
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator