Provider Demographics
NPI:1730354788
Name:WEISEND, STACY JACLYN (AUD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:JACLYN
Last Name:WEISEND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S MAIN ST
Mailing Address - Street 2:POLSKY BUIDING ROOM 181
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44325-3001
Mailing Address - Country:US
Mailing Address - Phone:330-972-6035
Mailing Address - Fax:330-972-7884
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:POLSKY BUILDING ROOM 181
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44325-3001
Practice Address - Country:US
Practice Address - Phone:330-972-6035
Practice Address - Fax:330-972-7884
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01564231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist