Provider Demographics
NPI:1073738852
Name:WEIMERSKIRCH, THEODORE (TED) JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THEODORE (TED)
Middle Name:JAMES
Last Name:WEIMERSKIRCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13407 BRISTOL TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9196
Mailing Address - Country:US
Mailing Address - Phone:260-637-6905
Mailing Address - Fax:
Practice Address - Street 1:13407 BRISTOL TRL
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9196
Practice Address - Country:US
Practice Address - Phone:260-637-6905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000187A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical