Provider Demographics
NPI:1235382490
Name:WEIDENBENNER, JOSEPH PAUL (LPC, MA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:WEIDENBENNER
Suffix:
Gender:M
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 CORBIN CIR SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-8175
Mailing Address - Country:US
Mailing Address - Phone:608-370-4169
Mailing Address - Fax:
Practice Address - Street 1:717 SOUTH BLVD STE 12
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-3139
Practice Address - Country:US
Practice Address - Phone:608-501-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4370-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional