Individual
AMY WIEDMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
210 AVENUE C, DANVILLE, IL 61832-5410
(217) 442-3200
(217) 442-7460
Mailing address
210 AVENUE C, DANVILLE, IL 61832-5410
(217) 442-3200
(217) 442-7460
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.015167
IL
Other
Enumeration date
05/21/2012
Last updated
03/17/2018
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