Provider Demographics
NPI:1407386576
Name:WIESMAN, WENDY (LSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WIESMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 APPLEBEE ST
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3035
Mailing Address - Country:US
Mailing Address - Phone:847-381-0345
Mailing Address - Fax:847-381-9297
Practice Address - Street 1:118 APPLEBEE ST
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3035
Practice Address - Country:US
Practice Address - Phone:847-381-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
IL150110430104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker