Provider Demographics
NPI:1427208735
Name:WEGRZYN, CARLA (MA CCC/SLP NYS LIC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:WEGRZYN
Suffix:
Gender:F
Credentials:MA CCC/SLP NYS LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 KELSEY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-3614
Mailing Address - Country:US
Mailing Address - Phone:716-692-1819
Mailing Address - Fax:
Practice Address - Street 1:3566 KELSEY LN
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-3614
Practice Address - Country:US
Practice Address - Phone:716-692-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008442-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist