Healthcare Provider Details

I. General information

NPI: 1689553091
Provider Name (Legal Business Name): NOGGIN WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 PHEASANT CREEK DR APT 101
NORTHBROOK IL
60062-3361
US

IV. Provider business mailing address

3070 PHEASANT CREEK DR APT 101
NORTHBROOK IL
60062-3361
US

V. Phone/Fax

Practice location:
  • Phone: 414-916-1969
  • Fax:
Mailing address:
  • Phone: 414-916-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: SEBASTIAN W. WEIGMAN
Title or Position: DEVELOPMENTAL THERAPIST
Credential: MSCD-DT, CCSC
Phone: 414-916-1969