Provider Demographics
NPI:1336374867
Name:WEISE, CHRISTINA ANN (MS BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:WEISE
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 NORTH GOUGAR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-9787
Mailing Address - Country:US
Mailing Address - Phone:618-566-4200
Mailing Address - Fax:618-566-3700
Practice Address - Street 1:606 SOUTH JEFFERSON
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-2615
Practice Address - Country:US
Practice Address - Phone:618-566-4200
Practice Address - Fax:618-566-3700
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst