Provider Demographics
NPI:1780041681
Name:WIESNER, SONIA L (LPC)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:L
Last Name:WIESNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9607 FRIENDSHIP DR APT 4
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-8555
Mailing Address - Country:US
Mailing Address - Phone:920-810-1533
Mailing Address - Fax:920-832-5488
Practice Address - Street 1:N9607 FRIENDSHIP DR APT 4
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-8555
Practice Address - Country:US
Practice Address - Phone:920-810-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10485-125101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100184841Medicaid