Provider Demographics
NPI:1386251148
Name:WEIS, ANDREW CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHARLES
Last Name:WEIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:WEIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:505 AMES ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2806
Mailing Address - Country:US
Mailing Address - Phone:507-581-2523
Mailing Address - Fax:
Practice Address - Street 1:158 WATER ST N STE 1
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2125
Practice Address - Country:US
Practice Address - Phone:507-649-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical