Provider Demographics
NPI:1619282092
Name:WEILER, ANNALISA RAIN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:ANNALISA
Middle Name:RAIN
Last Name:WEILER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3421
Mailing Address - Country:US
Mailing Address - Phone:503-709-4463
Mailing Address - Fax:
Practice Address - Street 1:810 E CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3421
Practice Address - Country:US
Practice Address - Phone:503-709-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 1041C0700X
WALW607767611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker