Provider Demographics
NPI:1538289434
Name:VONWEISS, CAROLYN M (MA, LP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:VONWEISS
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8897 AZTEC DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1901
Mailing Address - Country:US
Mailing Address - Phone:952-241-3102
Mailing Address - Fax:952-942-4936
Practice Address - Street 1:8897 AZTEC DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1901
Practice Address - Country:US
Practice Address - Phone:952-241-3102
Practice Address - Fax:952-942-4936
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3396103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist