Provider Demographics
NPI:1124108527
Name:WIECHENS, JULIE MICHELLE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MICHELLE
Last Name:WIECHENS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 EXECUTIVE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5607
Mailing Address - Country:US
Mailing Address - Phone:636-447-1902
Mailing Address - Fax:636-447-1902
Practice Address - Street 1:2440 EXECUTIVE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5607
Practice Address - Country:US
Practice Address - Phone:636-447-1902
Practice Address - Fax:636-447-1902
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010229881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO300138569OtherPROVIDER IDENTIFICATION
MO194696OtherPROVIDER IDENTIFICATION
MO494785314Medicaid
MO539410OtherPROVIDER IDENTIFICATION
MO494785314Medicaid