Provider Demographics
NPI:1992462485
Name:WEIGLE, RENAY KATHLEEN
Entity type:Individual
Prefix:MISS
First Name:RENAY
Middle Name:KATHLEEN
Last Name:WEIGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7480
Mailing Address - Country:US
Mailing Address - Phone:517-525-6563
Mailing Address - Fax:
Practice Address - Street 1:6296 BRIDGEPORT VILLAGE STREET DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722
Practice Address - Country:US
Practice Address - Phone:989-401-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician