Provider Demographics
NPI:1144363334
Name:WECKERLY, MAUREEN LYNN (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:LYNN
Last Name:WECKERLY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:LYNN
Other - Last Name:YABLONSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-0579
Mailing Address - Country:US
Mailing Address - Phone:724-549-8164
Mailing Address - Fax:
Practice Address - Street 1:5827 MERIDIAN ROAD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9404
Practice Address - Country:US
Practice Address - Phone:724-443-0700
Practice Address - Fax:724-443-4410
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
PASL008519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL008519OtherLICENSE