Provider Demographics
NPI:1386243186
Name:WEED, LINDA GALE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:GALE
Last Name:WEED
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 1:1702 MELODY CIR APT 122
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4970
Mailing Address - Country:US
Mailing Address - Phone:360-477-1881
Mailing Address - Fax:
Practice Address - Street 1:716 S CHASE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6122
Practice Address - Country:US
Practice Address - Phone:360-395-2976
Practice Address - Fax:360-395-2977
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61080733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)