Provider Demographics
NPI:1104924018
Name:WEYER, JESSICA ANN (MSW RAPCI LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:WEYER
Suffix:
Gender:
Credentials:MSW RAPCI LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 GLENWAY CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1120
Mailing Address - Country:US
Mailing Address - Phone:920-973-0167
Mailing Address - Fax:
Practice Address - Street 1:2675 N MAYFAIR RD STE 400
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1305
Practice Address - Country:US
Practice Address - Phone:414-763-6910
Practice Address - Fax:414-763-6911
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12995101YA0400X
104100000X
WI7359-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12995OtherRADCI
WI126638121OtherAPSW
WI41008500Medicaid