Doctor Name: | MR. JEFFREY AA WIENEKE |
NPI Number: | 1033373741 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S |
License Number: | |
Business Practice Address: | 117 S Cook St Pmb 327 Barrington, IL - 600104311 |
Business Phone Number: | 8479978947 |
Business Fax Number: | 8473048963 |
Mailing Address: | 117 S Cook St, Pmb 327 BARRINGTON |
State: | IL |
Postal Code: | 600104311 |
Phone Number: | 8479978947 |
Fax Number: | 8473048963 |
NPI Enumeration Date: | 07/11/2008 |
NPI Last Update Date: | 07/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |