Healthcare Provider Details

I. General information

NPI: 1225306400
Provider Name (Legal Business Name): ANN BRENNAN WEIDENHEIM LCSW,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN LOUISE BRENNAN LPC, LCSW

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 SOUTH AVE
LA CROSSE WI
54601-5429
US

IV. Provider business mailing address

1836 SOUTH AVE
LA CROSSE WI
54601-5429
US

V. Phone/Fax

Practice location:
  • Phone: 608-782-7300
  • Fax:
Mailing address:
  • Phone: 608-782-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number609-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1070-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: