Provider Demographics
NPI:1003394966
Name:WIEGMANN, CALEB JON
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:JON
Last Name:WIEGMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SYCAMORE AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3353
Mailing Address - Country:US
Mailing Address - Phone:319-230-9964
Mailing Address - Fax:
Practice Address - Street 1:502 WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NE
Practice Address - Zip Code:68745-1743
Practice Address - Country:US
Practice Address - Phone:402-256-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist