Healthcare Provider Details
I. General information
NPI: 1437358256
Provider Name (Legal Business Name): WEE SPEAK PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4543 CORMORANT DR
LAFAYETTE IN
47909-8204
US
IV. Provider business mailing address
4543 CORMORANT DR
LAFAYETTE IN
47909-8204
US
V. Phone/Fax
- Phone: 765-532-7420
- Fax: 765-477-9190
- Phone: 765-532-7420
- Fax: 765-477-9190
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 235Z00000X |
| Taxonomy | Speech-Language Pathologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
PENI
JEAN
SATTERFIELD
Title or Position: PRESIDENT
Credential: MS CCC SLP L
Phone: 765-532-7420