MEDICARE: JAMIE WEAVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2006012401	MO

General Provider Information

NPI Number	:	1053472852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE WEAVER

Provider Business Mailing Address
First Line	:	4916 W 96TH TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66207-3317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 E 44TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2168
Country	:	US
Telephone Number	:	816-921-0775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/24/2019

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Directions to “ JAMIE WEAVER ” Practice Location

Language	Start Address	Practice Location

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