Provider Demographics
NPI:1225355902
Name:WEEDEN & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WEEDEN & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WEEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCSW, CSAT
Authorized Official - Phone:262-375-9225
Mailing Address - Street 1:W67N222 EVERGREEN BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2650
Mailing Address - Country:US
Mailing Address - Phone:262-375-9225
Mailing Address - Fax:262-375-9005
Practice Address - Street 1:W67N222 EVERGREEN BLVD STE 111
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2650
Practice Address - Country:US
Practice Address - Phone:262-375-9225
Practice Address - Fax:262-375-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI432-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty