Provider Demographics
NPI:1164033361
Name:WEISENSEL, DONNA (DACM, LAC, LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WEISENSEL
Suffix:
Gender:F
Credentials:DACM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 SOUTHHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-8470
Mailing Address - Country:US
Mailing Address - Phone:847-769-1575
Mailing Address - Fax:
Practice Address - Street 1:4708 SOUTHHAMPTON DR
Practice Address - Street 2:
Practice Address - City:ISLAND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60042-8470
Practice Address - Country:US
Practice Address - Phone:847-769-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI994-55171100000X
IL227.016803225700000X
IL198.001476171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist