Provider Demographics
NPI:1871554154
Name:WESEMAN, PATRICIA (ST)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WESEMAN
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:WESEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3004 W FAIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4109
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:
Practice Address - Street 1:3004 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4109
Practice Address - Country:US
Practice Address - Phone:308-382-0344
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist