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DR. TIMOTHY C. WIEDEL PHD

Clinical Neuropsychologist

Wauwatosa, Wisconsin

Provider NPI: 1033208319

Provider Information:
DR. TIMOTHY C. WIEDEL PHD
Gender: M
Sole Proprietor


Practice Location:
7251 W NORTH AVE SUITE 5 WAUWATOSA, WI 53213 US
Tel: 414-248-2554  Fax: 414-302-4620

Business Mailing Address:
7251 W NORTH AVE SUITE 5 WAUWATOSA, WI 53213 US
Tel: 414-248-2554  Fax: 414-302-4620

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
WI1227-057
Y103TC0700XBehavioral Health & Social Service Providers
Psychologist
WI1227-057
N103TM1800XBehavioral Health & Social Service Providers
Psychologist
WI1227-057

Other Provider Identifiers:

IssuerNumberStateType
39071000WI05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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