Provider Demographics
NPI:1992973374
Name:WIEST-KERTZ, EVELYN JEAN (MS CCC-A)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:JEAN
Last Name:WIEST-KERTZ
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:JEAN
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:208 POINT PLZ
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2552
Mailing Address - Country:US
Mailing Address - Phone:724-283-3984
Mailing Address - Fax:724-283-3796
Practice Address - Street 1:208 POINT PLZ
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2552
Practice Address - Country:US
Practice Address - Phone:724-283-3984
Practice Address - Fax:724-283-3796
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000515L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019466760001Medicaid
216037OtherHIGHMARK
PA0019466760001Medicaid