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General NPI Number Information
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NPI Number | 1396180261
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Entity Type | Organization
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Legal Business Name | JAMES D WIEDENHOEFT PARTNERSHIP
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | N5367 MAYFLOWER RD
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City | SHIOCTON
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State | WI
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Zip | 54170-8934
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Country | US
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Telephone | 920-986-3003
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Fax | 920-986-3004
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Provider Business Mailing Address
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Address Line | N5367 MAYFLOWER RD
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City | SHIOCTON
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State | WI
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Zip | 54170-8934
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Country | US
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Telephone | 920-986-3003
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Fax | 920-986-3004
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | MISS ANN DAKE
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Credential |
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Telephone | 920-986-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 1447-226
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License Number State | WI
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