Provider Demographics
NPI:1447848502
Name:WEISSKOPF, WALTER MAX
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:MAX
Last Name:WEISSKOPF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4073 CHESTER DR APT 111
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7216
Mailing Address - Country:US
Mailing Address - Phone:205-577-1037
Mailing Address - Fax:
Practice Address - Street 1:4073 CHESTER DR APT 111
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-7216
Practice Address - Country:US
Practice Address - Phone:205-577-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician