Most Relevant Information
Provider Data
| NPI Number: | 1003463027 |
| Provider Name: | MADELYNN R WIETHOP LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 34010332A |
Most Important Dates
| Enumeration Date: | 08/23/2019 |
| Last Updated: | 05/03/2024 |
Provider Practice Location
7144 E VIRGINIA ST STE C
EVANSVILLE
IN
477159125
Practice Location Phone/Fax
| Phone: | 8124791242 |
| Fax: |
Provider Mailing Location
7144 E VIRGINIA ST STE C
EVANSVILLE
IN
477159125
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |