Individual
MADELYNN R WIETHOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7144 E VIRGINIA ST STE C, EVANSVILLE, IN 47715-9125
(812) 479-1242
Mailing address
7144 E VIRGINIA ST STE C, EVANSVILLE, IN 47715-9125
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34010332A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200238820
—
IN
Enumeration date
08/23/2019
Last updated
05/03/2024
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