Provider Demographics
NPI:1932243615
Name:WEHMEYER, BURNELL C (MS)
Entity Type:Individual
Prefix:MR
First Name:BURNELL
Middle Name:C
Last Name:WEHMEYER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 OGLE RD # B
Mailing Address - Street 2:B
Mailing Address - City:POLO
Mailing Address - State:IL
Mailing Address - Zip Code:61064-8804
Mailing Address - Country:US
Mailing Address - Phone:815-493-2605
Mailing Address - Fax:
Practice Address - Street 1:325 IL ROUTE 2
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9118
Practice Address - Country:US
Practice Address - Phone:815-284-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health