Provider Demographics
NPI:1033895958
Name:WEZENSKY, KATHLEEN (AU D)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WEZENSKY
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6873 E. BEAL CITY RD
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-621-1294
Mailing Address - Fax:
Practice Address - Street 1:10595 N. STRAITS HWY
Practice Address - Street 2:
Practice Address - City:CHEBOYGEN
Practice Address - State:MI
Practice Address - Zip Code:49721
Practice Address - Country:US
Practice Address - Phone:231-333-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-03-21
Deactivation Date:2024-03-14
Deactivation Code:
Reactivation Date:2024-03-21
Provider Licenses
StateLicense IDTaxonomies
MI1601001123231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist