Provider Demographics
NPI:1659821536
Name:WAIKEM, PARASKEVI ANASTASIA (SP12413)
Entity Type:Individual
Prefix:MRS
First Name:PARASKEVI
Middle Name:ANASTASIA
Last Name:WAIKEM
Suffix:
Gender:F
Credentials:SP12413
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 38TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709
Mailing Address - Country:US
Mailing Address - Phone:330-493-6082
Mailing Address - Fax:
Practice Address - Street 1:2100 38TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709
Practice Address - Country:US
Practice Address - Phone:330-492-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2016177235Z00000X
OHSP12413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist