Provider Demographics
NPI:1245415264
Name:WETZEL, MARGARET MARY (MS,SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:WETZEL
Suffix:
Gender:F
Credentials:MS,SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1122
Mailing Address - Country:US
Mailing Address - Phone:631-754-4793
Mailing Address - Fax:
Practice Address - Street 1:2171 JERICHO TPKE
Practice Address - Street 2:SUITE 340
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2937
Practice Address - Country:US
Practice Address - Phone:631-499-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008032-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist