# JAMES D WIEDENHOEFT PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396180261
- **Authorized official:** MISS ANN DAKE (FOUNDER/CEO)
- **Authorized official phone:** (920) 986-3003

## Contact information

- **Practice address:** N5367 MAYFLOWER RD, SHIOCTON, WI 54170-8934
- **Practice address phone:** (920) 986-3003
- **Practice address fax:** (920) 986-3004
- **Mailing address:** N5367 MAYFLOWER RD, SHIOCTON, WI 54170-8934
- **Mailing address phone:** (920) 986-3003
- **Mailing address fax:** (920) 986-3004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 1447-226 | WI | Yes |

## Other

- **Enumeration date:** 05/06/2013
- **Last updated:** 05/06/2013