Provider Demographics
NPI:1235382490
Name:WEIDENBENNER, JOSEPH PAUL (LPC, MA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:WEIDENBENNER
Suffix:
Gender:M
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 FRANKLIN ST
Mailing Address - Street 2:1
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1266
Mailing Address - Country:US
Mailing Address - Phone:608-370-4169
Mailing Address - Fax:
Practice Address - Street 1:6400 GISHOLT DR
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4835
Practice Address - Country:US
Practice Address - Phone:608-223-1506
Practice Address - Fax:608-223-1745
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4370-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional