Provider Demographics
NPI:1154501179
Name:WIESNER, DARLENE PEREZ (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:PEREZ
Last Name:WIESNER
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 1:1840 W 28TH ST
Mailing Address - Street 2:APT. 6
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3065
Mailing Address - Country:US
Mailing Address - Phone:216-394-0039
Mailing Address - Fax:
Practice Address - Street 1:1840 W 28TH ST
Practice Address - Street 2:APT. 6
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3065
Practice Address - Country:US
Practice Address - Phone:216-394-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist