MEDICARE: MISS JAMIE WEZENSKY M.S. CCC-SLP

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	101Y00000X	Counselor
2	235Z00000X	Speech-Language Pathologist	22006838A	IN

General Provider Information

NPI Number	:	1124312186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAMIE WEZENSKY M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	5941 NASH LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-5310
Country	:	US
Telephone Number	:	502-445-7631
Fax Number	:

Provider Business Practice Location Address
First Line	:	9957 ALLISONVILLE RD
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-2006
Country	:	US
Telephone Number	:	502-445-7631
Fax Number	:

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

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	11/12/2021

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Directions to “ MISS JAMIE WEZENSKY M.S. CCC-SLP” Practice Location

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