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General NPI Number Information
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NPI Number | 1760345151
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Entity Type | Individual
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Provider Name | TERENA WEITKAMP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 5737 S IRONWOOD RD
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City | SOUTH BEND
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State | IN
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Zip | 46614-9668
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Country | US
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Telephone | 419-348-7995
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Fax | 574-217-4589
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Provider Business Mailing Address
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Address Line | 51728 STATE HWY 933
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City | SOUTH BEND
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State | IN
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Zip | 46637
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Country | US
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Telephone | 419-348-7995
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Fax | 574-217-4589
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39005538A
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License Number State | IN
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