Provider Demographics
NPI:1225113277
Name:WEATHERS, MONICA
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:WEATHERS
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 1:1006 MINGO PL
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9223
Mailing Address - Country:US
Mailing Address - Phone:919-827-2763
Mailing Address - Fax:
Practice Address - Street 1:102 NORTH MARKET STREET
Practice Address - Street 2:SUITE FF
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504
Practice Address - Country:US
Practice Address - Phone:877-261-7323
Practice Address - Fax:877-261-7323
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411897Medicaid