Basic Information
| Provider Information | |||||||||
| NPI: | 1518122217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIDEMAN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 HIGHLAND AVE | ||||||||
| Address2: | SUITE N | ||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547011309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153797089 | ||||||||
| FaxNumber: | 7158358112 | ||||||||
| Practice Location | |||||||||
| Address1: | 2004 HIGHLAND AVE | ||||||||
| Address2: | SUITE N | ||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547014400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153797089 | ||||||||
| FaxNumber: | 7158358112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 09/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 851-124 | WI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.