MEDICARE: MRS. ANNETTE WIESEL BILINGUAL MA SLP CCC

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	011864-1	NY

General Provider Information

NPI Number	:	1932349032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNETTE WIESEL BILINGUAL MA SLP CCC

Provider Business Mailing Address
First Line	:	13808 78TH DR
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3238
Country	:	US
Telephone Number	:	718-591-1404
Fax Number	:	718-591-1409

Provider Business Practice Location Address
First Line	:	13808 78TH DR
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3238
Country	:	US
Telephone Number	:	718-591-1404
Fax Number	:	718-591-1409

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

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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Directions to “ MRS. ANNETTE WIESEL BILINGUAL MA SLP CCC” Practice Location

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