Provider Demographics
NPI:1851842975
Name:WIENMAN, KATE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:WIENMAN
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 1:175 E SOLITUDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9050
Mailing Address - Country:US
Mailing Address - Phone:260-341-5288
Mailing Address - Fax:
Practice Address - Street 1:175 E SOLITUDE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9050
Practice Address - Country:US
Practice Address - Phone:260-341-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3079235Z00000X
WYSP-846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist