Provider Demographics
NPI:1336588359
Name:WIEGERS, JACQUELINE SUSANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SUSANNE
Last Name:WIEGERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:SUSANNE
Other - Last Name:WIEGAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:743 COACHMAN DR
Mailing Address - Street 2:APT. 3
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1539
Mailing Address - Country:US
Mailing Address - Phone:248-376-8384
Mailing Address - Fax:
Practice Address - Street 1:222 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4504
Practice Address - Country:US
Practice Address - Phone:248-889-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000645231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist