Provider Demographics
NPI:1205864642
Name:WEISHEIT, JENNIFER A (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:WEISHEIT
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 1:2826 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1110
Mailing Address - Country:US
Mailing Address - Phone:812-630-2163
Mailing Address - Fax:
Practice Address - Street 1:1025 1ST AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3217
Practice Address - Country:US
Practice Address - Phone:812-630-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004373A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN213110BMedicare ID - Type UnspecifiedMEDICARE
INP34114Medicare UPIN