Provider Demographics
NPI:1437544798
Name:WETT, JOHN JACOB (MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JACOB
Last Name:WETT
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 TILTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1939
Mailing Address - Country:US
Mailing Address - Phone:815-570-9176
Mailing Address - Fax:
Practice Address - Street 1:104 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1932
Practice Address - Country:US
Practice Address - Phone:630-297-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist