Provider Demographics
NPI:1184321762
Name:WIELAND, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:WIELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29539 SKIPTON ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:MD
Mailing Address - Zip Code:21625-2730
Mailing Address - Country:US
Mailing Address - Phone:410-215-4243
Mailing Address - Fax:
Practice Address - Street 1:12 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3657
Practice Address - Country:US
Practice Address - Phone:410-822-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist