Provider Demographics
NPI:1154725679
Name:WEAVER, MARY ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5356
Mailing Address - Country:US
Mailing Address - Phone:816-418-8624
Mailing Address - Fax:816-418-5239
Practice Address - Street 1:1215 E TRUMAN RD
Practice Address - Street 2:DEPARTMENT OF EXCEPTIONAL EDUCATION
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-3152
Practice Address - Country:US
Practice Address - Phone:816-418-8624
Practice Address - Fax:816-418-5239
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0477426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist