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General NPI Number Information
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NPI Number | 1306948211
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Entity Type | Individual
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Provider Name | LANCE DAVID WIENER MA CCC SLP
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2785 NE 183RD ST
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City | AVENTURA
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State | FL
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Zip | 33160-2171
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Country | US
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Telephone | 305-932-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 20281 E COUNTRY CLUB DR APT 2504
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City | AVENTURA
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State | FL
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Zip | 33180-3010
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Country | US
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Telephone | 305-937-4972
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | SA510
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License Number State | FL
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