Provider Demographics
NPI:1366771867
Name:WEDDLE, MAUREEN (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:WEDDLE
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:DEVEREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:244 N MACY ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3362
Mailing Address - Country:US
Mailing Address - Phone:920-926-0050
Mailing Address - Fax:
Practice Address - Street 1:244 N MACY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3362
Practice Address - Country:US
Practice Address - Phone:920-926-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2910-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist