Provider Demographics
NPI:1588702682
Name:WEGNER, JANE R (PHD, CCC-SPL)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:WEGNER
Suffix:
Gender:F
Credentials:PHD, CCC-SPL
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:RUDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 SUNNYSIDE AVE
Mailing Address - Street 2:2101 HAWORTH HALL
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-0667
Mailing Address - Country:US
Mailing Address - Phone:785-864-4690
Mailing Address - Fax:785-864-5094
Practice Address - Street 1:1200 SUNNYSIDE AVE
Practice Address - Street 2:2101 HAWORTH HALL
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-0667
Practice Address - Country:US
Practice Address - Phone:785-864-4690
Practice Address - Fax:785-864-5094
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist