Provider Demographics
NPI:1053524082
Name:WIEDENHOFF, ALICE R (PHD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:R
Last Name:WIEDENHOFF
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:NORTH COUNTY CHILD STUDY CENTER, 6949 EL CAMINO REAL
Mailing Address - Street 2:STE. 201
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4140
Mailing Address - Country:US
Mailing Address - Phone:769-603-7770
Mailing Address - Fax:760-603-7753
Practice Address - Street 1:NORTH COUNTY CHILD STUDY CENTER, 6949 EL CAMINO REAL
Practice Address - Street 2:STE. 201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4140
Practice Address - Country:US
Practice Address - Phone:769-603-7770
Practice Address - Fax:760-603-7753
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17454103TC2200X
103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities