Individual
MR. LEA WEIDNER COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA LIC PSYCHOLOGIST
Contact information
Practice address
926 SOUTH 8TH STREET, MANITOWOC, WI 54221-1177
(920) 683-4230
(920) 683-4908
Mailing address
PO BOX 1177, 926 SOUTH 8TH STREET, MANITOWOC, WI 54221-1177
(920) 683-4230
(920) 683-4908
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1003057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39218600
—
WI
Enumeration date
04/22/2008
Last updated
04/22/2008
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