Provider Demographics
NPI:1902091895
Name:WEIGAND, PATRICIA A (BCBA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:WEIGAND
Suffix:
Gender:F
Credentials:BCBA
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 603
Mailing Address - Street 2:
Mailing Address - City:GLORIETA
Mailing Address - State:NM
Mailing Address - Zip Code:87535-0603
Mailing Address - Country:US
Mailing Address - Phone:505-603-5245
Mailing Address - Fax:
Practice Address - Street 1:14 RAVEN RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552-0603
Practice Address - Country:US
Practice Address - Phone:505-603-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-00-0212103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1-00-0212OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD