Provider Demographics
NPI:1033373741
Name:WIENEKE, JEFFREY AA (MS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:AA
Last Name:WIENEKE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S COOK ST
Mailing Address - Street 2:PMB 327
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4311
Mailing Address - Country:US
Mailing Address - Phone:847-997-8947
Mailing Address - Fax:847-304-8963
Practice Address - Street 1:117 S COOK ST
Practice Address - Street 2:PMB 327
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4311
Practice Address - Country:US
Practice Address - Phone:847-997-8947
Practice Address - Fax:847-304-8963
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist