Provider Demographics
NPI:1336160043
Name:WEIMER, GRETCHEN ROXANNE (MSLP)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:ROXANNE
Last Name:WEIMER
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:MRS
Other - First Name:GRETCHEN
Other - Middle Name:ROXANNE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSLP
Mailing Address - Street 1:908 STOCKTON RDG
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-2258
Mailing Address - Country:US
Mailing Address - Phone:412-512-1688
Mailing Address - Fax:
Practice Address - Street 1:908 STOCKTON RDG
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-2258
Practice Address - Country:US
Practice Address - Phone:412-512-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1497873Medicare UPIN