Provider Demographics
NPI:1013239342
Name:WEYER-SMITH, JAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:WEYER-SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W MORELAND BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2400
Mailing Address - Country:US
Mailing Address - Phone:262-542-0123
Mailing Address - Fax:262-542-1199
Practice Address - Street 1:707 W MORELAND BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2400
Practice Address - Country:US
Practice Address - Phone:262-542-0123
Practice Address - Fax:262-542-1199
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI442-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health