Provider Demographics
NPI:1215006473
Name:WEIGELE, LOUIS R (LISW, BCD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:R
Last Name:WEIGELE
Suffix:
Gender:M
Credentials:LISW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3424
Mailing Address - Country:US
Mailing Address - Phone:216-228-3500
Mailing Address - Fax:216-228-5818
Practice Address - Street 1:20525 CENTER RIDGE RD STE 303
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3424
Practice Address - Country:US
Practice Address - Phone:216-228-3500
Practice Address - Fax:216-228-5818
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-28181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH236744-000OtherMAGELLAN
OH1164592OtherCAQH
OH0211901Medicaid