Provider Demographics
NPI:1851643555
Name:WEINGART, PERRY (PSYD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:WEINGART
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ILLINOIS AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2963
Mailing Address - Country:US
Mailing Address - Phone:630-377-3535
Mailing Address - Fax:630-530-9527
Practice Address - Street 1:405 ILLINOIS AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2963
Practice Address - Country:US
Practice Address - Phone:630-377-3535
Practice Address - Fax:630-530-9527
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical