Provider Demographics
NPI:1336610559
Name:WEGRZYNOWSKI, AUDREY E (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:E
Last Name:WEGRZYNOWSKI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:E
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1535 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4921
Mailing Address - Country:US
Mailing Address - Phone:862-266-6207
Mailing Address - Fax:
Practice Address - Street 1:4225 EXECUTIVE SQ STE 1500
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1487
Practice Address - Country:US
Practice Address - Phone:844-812-8094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NMSLP6687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist