Healthcare Provider Details

I. General information

NPI: 1316652209
Provider Name (Legal Business Name): KATLYNN WEIDENSAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 KIRKWOOD HWY
WILMINGTON DE
19805-2121
US

IV. Provider business mailing address

1305 KIRKWOOD HWY
WILMINGTON DE
19805-2121
US

V. Phone/Fax

Practice location:
  • Phone: 302-440-6737
  • Fax:
Mailing address:
  • Phone: 302-440-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ3-0011416
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: