Provider Demographics
NPI:1346001542
Name:WEISS, MARY JUNE (BC, HIS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JUNE
Last Name:WEISS
Suffix:
Gender:F
Credentials:BC, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MOUNT AUBURN RD STE D
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4912
Mailing Address - Country:US
Mailing Address - Phone:573-651-3404
Mailing Address - Fax:573-651-0035
Practice Address - Street 1:201 SOUTH MOUNT AUBURN ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-651-3404
Practice Address - Fax:573-651-0035
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013019350237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist