Provider Demographics
NPI:1467629162
Name:WEILAND, NICHOLAS J (SLP)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:J
Last Name:WEILAND
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-9569
Mailing Address - Country:US
Mailing Address - Phone:740-593-1404
Mailing Address - Fax:740-593-4433
Practice Address - Street 1:112 E MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-593-1404
Practice Address - Fax:740-593-4433
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist