Individual
GINA FEDERAL WEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSP, CCC-SLP
Contact information
Practice address
3205 FREEDOM DR STE 7500, CHARLOTTE, NC 28208-3490
(980) 280-6526
Mailing address
4921 GRACE VIEW DR, PINEVILLE, NC 28134-7485
(704) 661-6456
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6375
SC
Other
Enumeration date
09/08/2017
Last updated
01/29/2020
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