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General NPI Number Information
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NPI Number | 1154725679
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Entity Type | Individual
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Provider Name | MARY ANNE WEAVER MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 1215 E TRUMAN RD DEPARTMENT OF EXCEPTIONAL EDUCATION
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City | KANSAS CITY
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State | MO
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Zip | 64106-3152
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Country | US
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Telephone | 816-418-8624
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Fax | 816-418-5239
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Provider Business Mailing Address
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Address Line | 2016 NE TUDOR RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5356
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Country | US
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Telephone | 816-418-8624
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Fax | 816-418-5239
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 0477426
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License Number State | MO
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