Provider Demographics
NPI:1699486985
Name:WESSELMANN, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:WESSELMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19515 PIN OAK RD
Mailing Address - Street 2:
Mailing Address - City:HOYLETON
Mailing Address - State:IL
Mailing Address - Zip Code:62803-2333
Mailing Address - Country:US
Mailing Address - Phone:161-832-2583
Mailing Address - Fax:
Practice Address - Street 1:522 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-2240
Practice Address - Country:US
Practice Address - Phone:618-566-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician