MEDICARE: MRS. KRISTIN M WEINGART MS 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	235Z00000X	Speech-Language Pathologist	6884	SC
2	235Z00000X	Speech-Language Pathologist	242004489	IL
3	235Z00000X	Speech-Language Pathologist	14174741

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215455134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN M WEINGART MS CCC-SLP

Provider Business Mailing Address
First Line	:	5000 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4500
Country	:	US
Telephone Number	:	843-318-9207
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4500
Country	:	US
Telephone Number	:	843-318-9207
Fax Number	:	843-582-0259

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	12/15/2023

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Directions to “ MRS. KRISTIN M WEINGART MS CCC-SLP” Practice Location

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