Provider Demographics
NPI:1558854208
Name:WAGSCHAL-WEISS, PENINA SARAH
Entity Type:Individual
Prefix:
First Name:PENINA
Middle Name:SARAH
Last Name:WAGSCHAL-WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14408 E CARROLL BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4604
Mailing Address - Country:US
Mailing Address - Phone:440-278-1029
Mailing Address - Fax:
Practice Address - Street 1:1111 SUPERIOR AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2522
Practice Address - Country:US
Practice Address - Phone:216-838-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2017385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist