Provider Demographics
NPI:1316458425
Name:WEINER, MARTHA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:WEINER
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 1:8320 TWILIGHT LN
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1565
Mailing Address - Country:US
Mailing Address - Phone:913-706-4150
Mailing Address - Fax:
Practice Address - Street 1:1460 NW VIVION RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4555
Practice Address - Country:US
Practice Address - Phone:816-853-0946
Practice Address - Fax:816-396-8809
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
KS1228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1228OtherKANSAS SLP LICENSE
KS1228OtherSPEECH PATHOLOGY LICENSE