Provider Demographics
NPI:1508117961
Name:WUELLENWEBER, JOHN W
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:WUELLENWEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FIELDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:NH
Mailing Address - Zip Code:03229-2676
Mailing Address - Country:US
Mailing Address - Phone:603-568-1115
Mailing Address - Fax:
Practice Address - Street 1:102 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-2676
Practice Address - Country:US
Practice Address - Phone:603-568-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH1243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health