Provider Demographics
NPI:1588476311
Name:WEYER, KIERSTEN (MT-BC)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:WEYER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 E DIVISION ST APT A
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-6690
Mailing Address - Country:US
Mailing Address - Phone:812-631-1334
Mailing Address - Fax:
Practice Address - Street 1:1908 E DIVISION ST APT A
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-6690
Practice Address - Country:US
Practice Address - Phone:812-631-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18088225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist