Provider Demographics
NPI:1992198527
Name:WIECZOREK, STEPHANIE S (AUD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:WIECZOREK
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 21ST AVE S
Practice Address - Street 2:SUITE 9302
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-8025
Practice Address - Country:US
Practice Address - Phone:615-936-6349
Practice Address - Fax:615-875-1410
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1678231H00000X
IN23002605A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist