Provider Demographics
NPI:1083174775
Name:WENBERG, MARGARET (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:WENBERG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 W DESERT INN RD APT 1059
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9113
Mailing Address - Country:US
Mailing Address - Phone:314-458-3406
Mailing Address - Fax:
Practice Address - Street 1:2560 MONTESSOURI ST STE 112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3063
Practice Address - Country:US
Practice Address - Phone:314-458-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty