Individual
ANITA H WIESE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
6831 N CHESTNUT ST, RAVENNA, OH 44266-3929
(330) 297-4564
Mailing address
533 E MAIN ST, RAVENNA, OH 44266-3218
(330) 297-9020
(330) 297-9095
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP8366
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP8366
OH BD OF SPEECH LANG PATH
OH
Enumeration date
10/28/2005
Last updated
07/08/2007
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