Provider Demographics
NPI:1578858395
Name:WIETING, MAGGIE M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:M
Last Name:WIETING
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 1:7636 GLYNOAKS DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6720
Mailing Address - Country:US
Mailing Address - Phone:402-802-4322
Mailing Address - Fax:
Practice Address - Street 1:7636 GLYNOAKS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6720
Practice Address - Country:US
Practice Address - Phone:402-802-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist