Provider Demographics
NPI:1578519336
Name:WEIGEL, MINDY SHAFER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:SHAFER
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 PATHWAY CLINIC
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53583
Mailing Address - Country:US
Mailing Address - Phone:608-643-3663
Mailing Address - Fax:
Practice Address - Street 1:560 PATHWAY CLINIC
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53583
Practice Address - Country:US
Practice Address - Phone:608-643-3663
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4170225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39795400Medicaid