Provider Demographics
NPI:1396590147
Name:WIEBE, KATHERINE RK (PSYD, PHD, MDIV)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RK
Last Name:WIEBE
Suffix:
Gender:F
Credentials:PSYD, PHD, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SIERRA MADRE VILLA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2040
Mailing Address - Country:US
Mailing Address - Phone:626-351-9616
Mailing Address - Fax:
Practice Address - Street 1:650 SIERRA MADRE VILLA AVE STE 110
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2040
Practice Address - Country:US
Practice Address - Phone:626-351-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist