MEDICARE: STEPHANIE WEISENBECK

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	503491	MN

General Provider Information

NPI Number	:	1578493508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE WEISENBECK

Provider Business Mailing Address
First Line	:	1156 W LAKEWOOD AVE
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-2175
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 W LAKEWOOD AVE
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-2175
Country	:	US
Telephone Number	:	651-345-4551
Fax Number	:

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

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “ STEPHANIE WEISENBECK ” Practice Location

Language	Start Address	Practice Location

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