Healthcare Provider Details

I. General information

NPI: 1114456050
Provider Name (Legal Business Name): KATELYN EVE WEDIG M.S, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN EVE WEDIG MS CCC-SLP

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 10/09/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 STONE ARBOR TRL VERONG
VERONA WI
53593-1476
US

IV. Provider business mailing address

502 STONE ARBOR TRL VERONG
VERONA WI
53593-1476
US

V. Phone/Fax

Practice location:
  • Phone: 715-323-3237
  • Fax:
Mailing address:
  • Phone: 715-323-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4471154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: