Provider Demographics
NPI:1629159629
Name:WIERWILLE, LINDA M (ICLSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:WIERWILLE
Suffix:
Gender:F
Credentials:ICLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5223
Mailing Address - Street 2:WEST LEBANON VILLAGE PLAZA
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784
Mailing Address - Country:US
Mailing Address - Phone:603-298-8237
Mailing Address - Fax:603-298-8281
Practice Address - Street 1:CHILD AND FAMILY SERVICES 3 ABBOTT AVENUE
Practice Address - Street 2:WEST LEBANON PLAZA
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784
Practice Address - Country:US
Practice Address - Phone:603-298-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist