Individual
KEITH WARREN WEIGOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS., CCC-SLP
Contact information
Practice address
100 NETHERLAND LN, KINGSPORT, TN 37660-7245
(423) 438-8641
Mailing address
345 OASIS RD, BULLS GAP, TN 37711-2045
(423) 438-8641
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
13461
NC
235Z00000X
Speech-Language Pathologist
Primary
4200
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669774543
—
TN
Enumeration date
11/24/2010
Last updated
04/23/2019
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