Provider Demographics
NPI:1316980865
Name:WEYROUGH, JOHN J (MSSW, LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:WEYROUGH
Suffix:
Gender:M
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N BEAUMONT RD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1445
Mailing Address - Country:US
Mailing Address - Phone:608-326-0248
Mailing Address - Fax:608-326-4395
Practice Address - Street 1:225 N BEAUMONT RD
Practice Address - Street 2:SUITE 326
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1445
Practice Address - Country:US
Practice Address - Phone:608-326-0248
Practice Address - Fax:608-326-4395
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6781-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40944800Medicaid
WI241790OtherMIDLAND CHOICE
WI40944800Medicaid