Individual
MS. JENNIFER LEIGH WEIDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
74 ECLIPSE CTR, BELOIT, WI 53511-3550
(608) 361-0311
Mailing address
74 ECLIPSE CTR, BELOIT, WI 53511-3550
(608) 361-0311
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6135-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43574600
—
WI
01
—
6135-123
LCSW
WI
Enumeration date
01/04/2007
Last updated
11/05/2018
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