Provider Demographics
NPI:1518120849
Name:WEIMER, SHANNAN MARIE (MA CCC/L-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:MARIE
Last Name:WEIMER
Suffix:
Gender:F
Credentials:MA CCC/L-SLP
Other - Prefix:MISS
Other - First Name:SHANNAN
Other - Middle Name:MARIE
Other - Last Name:GREGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/L-SLP
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:COUNTYLINE ROAD
Mailing Address - City:YORKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:14173-0579
Mailing Address - Country:US
Mailing Address - Phone:716-492-9300
Mailing Address - Fax:
Practice Address - Street 1:12125 COUNTYLINE ROAD
Practice Address - Street 2:YORKSHIRE-PIONEER CENTRAL SCHOOL DISTRICT
Practice Address - City:YORKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:14173-0579
Practice Address - Country:US
Practice Address - Phone:716-492-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007291-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist