Provider Demographics
NPI:1497202469
Name:WIEDMAYER, RONA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RONA
Middle Name:
Last Name:WIEDMAYER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WHIPPOORWILL LANE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1332
Mailing Address - Country:US
Mailing Address - Phone:862-266-0419
Mailing Address - Fax:
Practice Address - Street 1:46 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1332
Practice Address - Country:US
Practice Address - Phone:862-266-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00372300235Z00000X
FLSA782235Z00000X
PASL006012L235Z00000X
NY58 011464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist