Provider Demographics
NPI:1962151209
Name:WEISNER, SJOFN CATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:SJOFN
Middle Name:CATHLEEN
Last Name:WEISNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772752
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-2752
Mailing Address - Country:US
Mailing Address - Phone:907-854-5660
Mailing Address - Fax:
Practice Address - Street 1:22253 ELKHORN CIRCLE
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-2752
Practice Address - Country:US
Practice Address - Phone:907-854-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK54101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health