Provider Demographics
NPI:1043254238
Name:WEESNER, KAREN S (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:WEESNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-9730
Mailing Address - Country:US
Mailing Address - Phone:812-883-3095
Mailing Address - Fax:812-883-4405
Practice Address - Street 1:1321 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-9730
Practice Address - Country:US
Practice Address - Phone:812-883-3095
Practice Address - Fax:812-883-4405
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002457A101YM0800X, 1041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN895790TMedicare ID - Type UnspecifiedMEDICARE