Individual
LEESA MARIE WIEDHOLZ-ABBOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3734 7TH AVE, SUITE 12, KENOSHA, WI 53140-5525
(262) 654-9370
(262) 654-9379
Mailing address
815 NORTHDALE DR, RACINE, WI 53402-2759
(262) 752-4205
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2352-057
WI
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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