Healthcare Provider Details

I. General information

NPI: 1497477574
Provider Name (Legal Business Name): HANNAH MARIE WEISS LPC-IT, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 HAYES RD STE 201
MADISON WI
53704-7364
US

IV. Provider business mailing address

1706 LAKE POINT DR APT 101
MADISON WI
53713-1723
US

V. Phone/Fax

Practice location:
  • Phone: 608-400-5116
  • Fax: 608-630-8089
Mailing address:
  • Phone: 920-627-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7113226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7113226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: