Individual
KELLY WEIDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20439 GLEN VISTA LN, CREST HILL, IL 60435-0729
(815) 836-3965
(815) 836-9930
Mailing address
20439 GLEN VISTA LN, CREST HILL, IL 60435-0729
(815) 836-3965
(815) 836-9930
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
KW16880304P
IL
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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