Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1033373741 |
---|---|
Provider Name | Mr. Jeffrey Aa Wieneke |
First Address | Barrington, IL 60010-4311 |
Second Address | Barrington, IL 60010-4311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 11/07/2008 |