Provider Demographics
NPI:1760500680
Name:WEESE, ANISSA NICHOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:NICHOLE
Last Name:WEESE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BLACK OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COWEN
Mailing Address - State:WV
Mailing Address - Zip Code:26206
Mailing Address - Country:US
Mailing Address - Phone:276-608-1693
Mailing Address - Fax:865-381-1275
Practice Address - Street 1:84 BLACK OAK DRIVE
Practice Address - Street 2:
Practice Address - City:COWEN
Practice Address - State:WV
Practice Address - Zip Code:26206
Practice Address - Country:US
Practice Address - Phone:276-608-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-2466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV39-3212950OtherFEIN