Provider Demographics
NPI:1396913927
Name:WEISHAAR, JEFFREY R (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:WEISHAAR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W379S9674 COUNTY RD S
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:WI
Mailing Address - Zip Code:53119-1501
Mailing Address - Country:US
Mailing Address - Phone:715-864-9326
Mailing Address - Fax:
Practice Address - Street 1:1491 S BELL SCHOOL RD STE 3
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1407
Practice Address - Country:US
Practice Address - Phone:866-874-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007616103TC0700X
IL178005415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional