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NPI Code Detail

MEDICARE: DEANNA JO WIESE M.S., CCC-SLP

MEDICARE: DEANNA JO WIESE 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
1235Z00000XSpeech-Language Pathologist22002134AIN

General Provider Information

NPI Number : 1699803783
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA JO WIESE M.S., CCC-SLP
Provider Business Mailing Address
First Line : 3520 WILD IVY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-9731
Country : US
Telephone Number : 317-633-9115
Fax Number : 317-889-3150
Provider Business Practice Location Address
First Line : 13520 ASHBURY DR
Second Line :
City : CARMEL
State : IN
Zip : 46032-8225
Country : US
Telephone Number : 800-900-6304
Fax Number : 317-846-9484
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/08/2007

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Directions to “ DEANNA JO WIESE M.S., CCC-SLP” Practice Location

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