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General NPI Number Information
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NPI Number | 1497921183
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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 | 05/02/2008
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Last Update Date | 02/04/2014
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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 | CEO
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Name | MS. ANN M DAKE
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Credential | LCSW
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1578
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License Number State | WI
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