Provider Demographics
NPI:1346857042
Name:WEIGAND, COURTNEY LAUREN (HIS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LAUREN
Last Name:WEIGAND
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LAUREN
Other - Last Name:SHOPSHIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:3928B W SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:JB MDL
Mailing Address - State:NJ
Mailing Address - Zip Code:08641-1683
Mailing Address - Country:US
Mailing Address - Phone:774-487-8161
Mailing Address - Fax:
Practice Address - Street 1:269 WINTER ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2962
Practice Address - Country:US
Practice Address - Phone:774-487-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA479237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty