Individual
MS. MARY LYNN WIETZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCCSLP
Contact information
Practice address
5500 ARMSTRONG ROAD-114 PR, VA MEDICAL CENTER, BATTLE CREEK, MI 49015-1099
(269) 966-5600
Mailing address
5500 ARMSTRONG ROAD-114 PR, VA MEDICAL CENTER, BATTLE CREEK, MI 49015-1099
(269) 966-5600
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
01073833
—
Other
Enumeration date
07/28/2006
Last updated
07/08/2007
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