Provider Demographics
NPI:1902479900
Name:WEGMAN, EMILY LEANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LEANNE
Last Name:WEGMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BENGAL TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2807
Mailing Address - Country:US
Mailing Address - Phone:585-355-7180
Mailing Address - Fax:
Practice Address - Street 1:65 BENGAL TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-2807
Practice Address - Country:US
Practice Address - Phone:585-355-7180
Practice Address - Fax:585-625-0078
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty