Individual
MARK WEITKUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
797 E GENEVA ST, ELKHORN, WI 53121-2303
(262) 723-1455
(262) 723-1556
Mailing address
285 N JANACEK RD, BROOKFIELD, WI 53045-6102
(262) 641-9050
(262) 641-9126
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13705-130
WI
Other
Enumeration date
05/19/2009
Last updated
05/19/2009
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