Provider Demographics
NPI:1932349032
Name:WIESEL, ANNETTE (BILINGUAL MA SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:WIESEL
Suffix:
Gender:F
Credentials:BILINGUAL MA SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13808 78TH DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3238
Mailing Address - Country:US
Mailing Address - Phone:718-591-1404
Mailing Address - Fax:718-591-1409
Practice Address - Street 1:13808 78TH DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3238
Practice Address - Country:US
Practice Address - Phone:718-591-1404
Practice Address - Fax:718-591-1409
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011864-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist