Provider Demographics
NPI:1922266469
Name:WEILER, DEANNE MARIE (MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:MARIE
Last Name:WEILER
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COTTONWOOD AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029
Mailing Address - Country:US
Mailing Address - Phone:414-510-3280
Mailing Address - Fax:262-367-3828
Practice Address - Street 1:300 COTTONWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2043
Practice Address - Country:US
Practice Address - Phone:414-510-3280
Practice Address - Fax:262-367-3828
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1736-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39698300Medicaid