Provider Demographics
NPI:1689707184
Name:WEIGEL, CONCETTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONCETTA
Middle Name:
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 MERLOT CT
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6755
Mailing Address - Country:US
Mailing Address - Phone:847-818-9644
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY
Practice Address - Street 2:SUITE 228
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1444
Practice Address - Country:US
Practice Address - Phone:847-298-1111
Practice Address - Fax:847-298-1161
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206842Medicare ID - Type Unspecified