Provider Demographics
NPI:1467636480
Name:WIELGASZ, KIM MARIE (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:WIELGASZ
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Gender:F
Credentials:MS CCC/SLP
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Mailing Address - Street 1:50 EAST NORTH STREET
Mailing Address - Street 2:BUFFALO HEARING AND SPEECH CENTER
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:716-885-8318
Mailing Address - Fax:716-885-0229
Practice Address - Street 1:50 EAST NORTH STREET
Practice Address - Street 2:BUFFALO HEARING AND SPEECH CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-885-8318
Practice Address - Fax:716-885-0229
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
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Provider Licenses
StateLicense IDTaxonomies
NY0119821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist