Healthcare Provider Details

I. General information

NPI: 1730354788
Provider Name (Legal Business Name): STACY JACLYN WEISEND AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S MAIN ST POLSKY BUILDING ROOM 181
AKRON OH
44325-3001
US

IV. Provider business mailing address

225 S MAIN ST POLSKY BUIDING ROOM 181
AKRON OH
44325-3001
US

V. Phone/Fax

Practice location:
  • Phone: 330-972-6035
  • Fax: 330-972-7884
Mailing address:
  • Phone: 330-972-6035
  • Fax: 330-972-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-01564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: