Leesa Marie Wiedholz-Abbott, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2352-057 Issued in WI

Practice address

3734 7TH Ave
Suite 12
Kenosha, WI 53140-5525

Phone

(262) 654-9370

Fax

(262) 654-9379

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Leesa Marie Wiedholz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aalto Enhancement Center, S.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kenosha, WI
  • NPI 1629155973
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952482267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 NORTHDALE DR",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534022759",
            "telephone_number": "262-752-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3734 7TH AVE",
            "address_2": "SUITE 12",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405525",
            "telephone_number": "262-654-9370",
            "fax_number": "262-654-9379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDHOLZ-ABBOTT",
        "first_name": "LEESA",
        "middle_name": "MARIE",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2352-057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEESA",
            "last_name": "WIEDHOLZ",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James J White, CERTIFIED OPTICIAN
• Rayme White, OTR/L
• Therese Marie Whitt, MD
• Maryann Cathrine Widzins, RN
• Melissa Wiedenhoeft, MS, CF-SLP
• Wiesztort Family Chiropractic Clinic, S.C.
• Walter Rudolph Wiesztort, D.C.
• April Brianna Wight, MSW, APSW
• Deana Mechelle Wiley, LPC-IT
• Kendall Wilkes, DMD

• Clinical Psychologist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.