Healthcare Provider Details

I. General information

NPI: 1760500680
Provider Name (Legal Business Name): ANISSA NICHOLE WEESE MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 BLACK OAK DRIVE
COWEN WV
26206
US

IV. Provider business mailing address

84 BLACK OAK DRIVE
COWEN WV
26206
US

V. Phone/Fax

Practice location:
  • Phone: 276-608-1693
  • Fax:
Mailing address:
  • Phone: 276-608-1693
  • Fax: 865-381-1275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-2466
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: