Healthcare Provider Details

I. General information

NPI: 1043254238
Provider Name (Legal Business Name): KAREN S WEESNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S JACKSON ST
SALEM IN
47167-9730
US

IV. Provider business mailing address

1321 S JACKSON ST
SALEM IN
47167-9730
US

V. Phone/Fax

Practice location:
  • Phone: 812-883-3095
  • Fax: 812-883-4405
Mailing address:
  • Phone: 812-883-3095
  • Fax: 812-883-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34002457A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002457A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number34002457A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: