Provider Demographics
NPI:1255516001
Name:WIER, THERESA MARIE (PSYD, LPC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:WIER
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 LAKE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1085
Mailing Address - Country:US
Mailing Address - Phone:708-256-6358
Mailing Address - Fax:708-524-8758
Practice Address - Street 1:1101 LAKE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1085
Practice Address - Country:US
Practice Address - Phone:708-256-6358
Practice Address - Fax:708-524-8758
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008216103TC0700X
IL178005286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional