Provider Demographics
NPI:1881860559
Name:WEIMERSKIRCH, SUSAN A (MSSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:WEIMERSKIRCH
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S 24TH AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5242
Mailing Address - Country:US
Mailing Address - Phone:715-848-1457
Mailing Address - Fax:
Practice Address - Street 1:705 S 24TH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5242
Practice Address - Country:US
Practice Address - Phone:715-848-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI434-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39568200Medicaid