Provider Demographics
NPI:1437998572
Name:WESP, SAMUEL JOHN (HIS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOHN
Last Name:WESP
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 TOWER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5328
Mailing Address - Country:US
Mailing Address - Phone:715-392-2172
Mailing Address - Fax:
Practice Address - Street 1:3215 TOWER AVE STE 103
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5328
Practice Address - Country:US
Practice Address - Phone:715-392-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2052-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist