Provider Demographics
NPI:1073054540
Name:WEITZEL, TIMOTHY (LISW-S)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WEITZEL
Suffix:
Gender:
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1849
Mailing Address - Country:US
Mailing Address - Phone:419-626-5623
Mailing Address - Fax:419-626-8778
Practice Address - Street 1:501 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4487
Practice Address - Country:US
Practice Address - Phone:567-304-3900
Practice Address - Fax:567-304-3902
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1440295-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical