Provider Demographics
NPI:1386764926
Name:LINDA R. WIESELER, INC.
Entity type:Organization
Organization Name:LINDA R. WIESELER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESELER
Authorized Official - Suffix:II
Authorized Official - Credentials:MSE, LMHC
Authorized Official - Phone:712-490-2515
Mailing Address - Street 1:1003 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2734
Mailing Address - Country:US
Mailing Address - Phone:712-490-2515
Mailing Address - Fax:712-277-3173
Practice Address - Street 1:705 DOUGLAS ST STE 350
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1018
Practice Address - Country:US
Practice Address - Phone:712-490-2515
Practice Address - Fax:712-277-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01491251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01491OtherMASTER SOCIAL WORKER
IA1014704Medicaid
IA00994OtherMENTAL HEALTH COUNSELOR
IA10418OtherFAMILY TEEM MTG FACILITAT
IA00994OtherMENTAL HEALTH COUNSELOR
NE1975OtherMENTAL HEALTH PRACTITIONE