Provider Demographics
NPI:1821502568
Name:WEEDEN, JOANNE (BC-HIS)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2932
Mailing Address - Country:US
Mailing Address - Phone:941-556-4264
Mailing Address - Fax:
Practice Address - Street 1:1901 FLOYD ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2932
Practice Address - Country:US
Practice Address - Phone:941-556-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1535-60237700000X
SCHAS0708237700000X
FLAS5643237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821502568Medicaid