Provider Demographics
NPI:1427309475
Name:WEAVER, VERONICA KLOCKO (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:KLOCKO
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 1:927 FARRAGUT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3942
Mailing Address - Country:US
Mailing Address - Phone:202-483-2122
Mailing Address - Fax:
Practice Address - Street 1:10605 CONCORD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2504
Practice Address - Country:US
Practice Address - Phone:917-841-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-29
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist