Provider Demographics
NPI:1760941116
Name:WEDIG, QUINTON RICHARD (SAC)
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:RICHARD
Last Name:WEDIG
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ALPINE MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3832
Mailing Address - Country:US
Mailing Address - Phone:608-206-7804
Mailing Address - Fax:
Practice Address - Street 1:2914 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4047
Practice Address - Country:US
Practice Address - Phone:608-223-3311
Practice Address - Fax:608-204-8585
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16291101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health