Provider Demographics
NPI:1568644011
Name:WIEBER, ERIC PAUL (MA CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:PAUL
Last Name:WIEBER
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 1:15 PINE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11977-1324
Mailing Address - Country:US
Mailing Address - Phone:631-325-1825
Mailing Address - Fax:
Practice Address - Street 1:15 PINE GROVE CT
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1324
Practice Address - Country:US
Practice Address - Phone:631-325-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009468-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist