Provider Demographics
NPI:1386043800
Name:WEIMER, ANISSA (MS)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:WEIMER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 BRIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24139-3302
Mailing Address - Country:US
Mailing Address - Phone:434-441-0137
Mailing Address - Fax:
Practice Address - Street 1:4710 BRIGHTS RD
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24139-3302
Practice Address - Country:US
Practice Address - Phone:434-441-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist