Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | POST-DOC SUPERVISEE | KS |
NPI | 1003192881 |
---|---|
Provider Name | Dr. Ashley Heintzelman Wiedenmeyer |
First Address | Prairie Village, KS 66208-3613 |
Second Address | Prairie Village, KS 66208-3613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 25/10/2011 |