Provider Demographics
NPI:1194212050
Name:WEISBROD, JANA
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:WEISBROD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 LAWNVIEW CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4710
Mailing Address - Country:US
Mailing Address - Phone:810-210-1182
Mailing Address - Fax:
Practice Address - Street 1:1217 LAWNVIEW CT
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4710
Practice Address - Country:US
Practice Address - Phone:810-210-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist