Provider Demographics
NPI:1033295902
Name:WIEGAND, DANIELLA LYDIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLA
Middle Name:LYDIA
Last Name:WIEGAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 LAKEVIEW PARKWAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-549-6650
Mailing Address - Fax:847-549-8006
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:847-549-6650
Practice Address - Fax:847-549-8006
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical