Provider Demographics
NPI:1639295603
Name:WEISE, LINDA JO (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JO
Last Name:WEISE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 FIELDBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-5002
Mailing Address - Country:US
Mailing Address - Phone:847-487-0370
Mailing Address - Fax:
Practice Address - Street 1:675 N NORTH CT STE 380
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8131
Practice Address - Country:US
Practice Address - Phone:847-327-1409
Practice Address - Fax:847-705-0147
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional