Provider Demographics
NPI:1225704968
Name:WESELOH, ADAM ELLIOTT (PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:ELLIOTT
Last Name:WESELOH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:MINIER
Mailing Address - State:IL
Mailing Address - Zip Code:61759-0741
Mailing Address - Country:US
Mailing Address - Phone:309-840-0634
Mailing Address - Fax:
Practice Address - Street 1:808 S ELDORADO RD STE 300
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6009
Practice Address - Country:US
Practice Address - Phone:309-827-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist