Provider Demographics
NPI:1275911166
Name:WIELERT, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WIELERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILFORD LOOP
Mailing Address - Street 2:BLDG 4554, WILFORD HALL AMBULATORY SURGICAL CENTER
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-292-5339
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD LOOP
Practice Address - Street 2:BLDG 4554, WILFORD HALL AMBULATORY SURGICAL CENTER
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1152A231H00000X
GAAUD004157231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist