Provider Demographics
NPI:1679385777
Name:WEYENBERG, SHARI LYNN
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:LYNN
Last Name:WEYENBERG
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 1:225 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2932
Mailing Address - Country:US
Mailing Address - Phone:920-475-7307
Mailing Address - Fax:
Practice Address - Street 1:145 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3075
Practice Address - Country:US
Practice Address - Phone:920-725-1230
Practice Address - Fax:920-215-1664
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2947103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical