Provider Demographics
NPI:1871989426
Name:WEBER WILCOX, JANEL LYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:JANEL
Middle Name:LYNN
Last Name:WEBER WILCOX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-0616
Mailing Address - Country:US
Mailing Address - Phone:814-362-4621
Mailing Address - Fax:814-362-1066
Practice Address - Street 1:723 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3242
Practice Address - Country:US
Practice Address - Phone:814-362-4621
Practice Address - Fax:814-362-1066
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01005L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist