Provider Demographics
NPI:1346723269
Name:DEWITT, WESLEY ALAN
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:ALAN
Last Name:DEWITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 COLDWATER RD STE G
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-8400
Mailing Address - Country:US
Mailing Address - Phone:260-489-2222
Mailing Address - Fax:260-490-6666
Practice Address - Street 1:411 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1428
Practice Address - Country:US
Practice Address - Phone:260-624-2600
Practice Address - Fax:260-624-2602
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001505A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist