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General NPI Number Information
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NPI Number | 1891563789
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Entity Type | Organization
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Legal Business Name | WIEMELT THERAPY SERVICES
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 3716 BISCAYNE ST
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City | QUINCY
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State | IL
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Zip | 62305-4742
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Country | US
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Telephone | 217-653-8520
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 BISCAYNE ST
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City | QUINCY
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State | IL
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Zip | 62305-4742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | PAIGE WIEMELT
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Credential | LCSW
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Telephone | 217-653-8520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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