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General NPI Number Information
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NPI Number | 1033373741
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Entity Type | Individual
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Provider Name | JEFFREY AA WIENEKE M.S
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Gender | Male
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 117 S COOK ST PMB 327
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City | BARRINGTON
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State | IL
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Zip | 60010-4311
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Country | US
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Telephone | 847-997-8947
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Fax | 847-304-8963
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Provider Business Mailing Address
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Address Line | 117 S COOK ST PMB 327
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City | BARRINGTON
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State | IL
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Zip | 60010-4311
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Country | US
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Telephone | 847-997-8947
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Fax | 847-304-8963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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