Provider Demographics
NPI:1366442543
Name:WEAVER, JON FREDERICK (MA,CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:FREDERICK
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 S DIXON RD #F
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-7320
Mailing Address - Country:US
Mailing Address - Phone:765-457-4261
Mailing Address - Fax:765-452-7655
Practice Address - Street 1:1542S DIXON RD F
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-7320
Practice Address - Country:US
Practice Address - Phone:765-457-4261
Practice Address - Fax:754-455-2577
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001956A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist