Provider Demographics
NPI:1538482583
Name:JEFF WEISHAAR, PSY.D., P.C.
Entity Type:Organization
Organization Name:JEFF WEISHAAR, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEISHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:715-864-9326
Mailing Address - Street 1:2012 CROOKED TREE CT
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3993
Mailing Address - Country:US
Mailing Address - Phone:715-864-9326
Mailing Address - Fax:815-344-2448
Practice Address - Street 1:2012 CROOKED TREE CT
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3993
Practice Address - Country:US
Practice Address - Phone:715-864-9326
Practice Address - Fax:815-344-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1446Medicare PIN
ILIL1447Medicare PIN
ILIL1448Medicare PIN