Provider Demographics
NPI:1518122217
Name:WEIDEMAN, ANGELA K (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:K
Last Name:WEIDEMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HIGHLAND AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-1309
Mailing Address - Country:US
Mailing Address - Phone:715-379-7089
Mailing Address - Fax:715-835-8112
Practice Address - Street 1:2004 HIGHLAND AVE
Practice Address - Street 2:SUITE N
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4400
Practice Address - Country:US
Practice Address - Phone:715-379-7089
Practice Address - Fax:715-835-8112
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI851-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist