Provider Demographics
NPI:1245575463
Name:VANDERWEELE, DEBRA LEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:VANDERWEELE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7012 RIVERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-1658
Mailing Address - Country:US
Mailing Address - Phone:920-467-6813
Mailing Address - Fax:
Practice Address - Street 1:2801 CALUMET DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-3839
Practice Address - Country:US
Practice Address - Phone:920-451-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1576125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health