Provider Demographics
NPI:1235481060
Name:WEIRATHER, RANDY R (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:R
Last Name:WEIRATHER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-260 AHUI NANI PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4051
Mailing Address - Country:US
Mailing Address - Phone:808-341-3716
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR
Practice Address - Street 2:104/108
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1855
Practice Address - Country:US
Practice Address - Phone:808-373-4787
Practice Address - Fax:808-373-4787
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist