Provider Demographics
NPI:1275201873
Name:WEISSERT, MEREDITH ELIZABETH (MA, LCPC, R-DMT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ELIZABETH
Last Name:WEISSERT
Suffix:
Gender:F
Credentials:MA, LCPC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 W PALMER ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3517
Mailing Address - Country:US
Mailing Address - Phone:847-609-9008
Mailing Address - Fax:
Practice Address - Street 1:2400 N ASHLAND AVE # 174
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2021
Practice Address - Country:US
Practice Address - Phone:773-270-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional