Individual
MR. JAMES D WIEDENHOEFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1049 N LYNNDALE DR, 1B, APPLETON, WI 54914-3050
(262) 345-5599
(262) 345-5608
Mailing address
W175N11120 STONEWOOD DR, GERMANTOWN, WI 53022-6511
(262) 345-5560
(262) 345-5531
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2781-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2781-123
LCSW
WI
01
—
39-1047224
TAX ID
WI
05
—
39668500
—
WI
Enumeration date
05/08/2007
Last updated
07/16/2014
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