Provider Demographics
NPI:1588877526
Name:WIMMER, MICHELE LISA (CSA)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LISA
Last Name:WIMMER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 701
Mailing Address - Street 2:
Mailing Address - City:TWIN PEAKS
Mailing Address - State:CA
Mailing Address - Zip Code:92391-0701
Mailing Address - Country:US
Mailing Address - Phone:909-338-9969
Mailing Address - Fax:909-338-2341
Practice Address - Street 1:993 PLAYGROUND DR.
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325
Practice Address - Country:US
Practice Address - Phone:909-338-9969
Practice Address - Fax:909-338-2341
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator