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General NPI Number Information
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NPI Number | 1194986588
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Entity Type | Individual
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Provider Name | LISA JO WEBER SEDLAK M.S.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 2600 65TH AVE
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City | OSCEOLA
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State | WI
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Zip | 54020
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Country | US
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Telephone | 715-294-4752
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 217
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City | SOMERSET
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State | WI
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Zip | 54025-0217
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Country | US
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Telephone | 715-247-2802
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Fax | 715-247-2802
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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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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 660124
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1054
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License Number State | MN
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