Provider Demographics
NPI:1750681458
Name:WECKERLE, DONNA MARY (AUD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARY
Last Name:WECKERLE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEATHERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2083
Mailing Address - Country:US
Mailing Address - Phone:315-214-4579
Mailing Address - Fax:
Practice Address - Street 1:100 WEATHERIDGE DR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2083
Practice Address - Country:US
Practice Address - Phone:315-214-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY816237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter