Provider Demographics
NPI:1497227136
Name:WEAVER, KAYCIE NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KAYCIE
Middle Name:NICOLE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HAWTHORNE CIR
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9742
Mailing Address - Country:US
Mailing Address - Phone:724-771-4246
Mailing Address - Fax:
Practice Address - Street 1:999 W HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-4801
Practice Address - Country:US
Practice Address - Phone:717-944-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist