Provider Demographics
NPI:1548458508
Name:WEED, LIBBY LUANN (MA SLP)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:LUANN
Last Name:WEED
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 W MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-5423
Mailing Address - Country:US
Mailing Address - Phone:316-204-5739
Mailing Address - Fax:
Practice Address - Street 1:514 S MARTINSON ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3927
Practice Address - Country:US
Practice Address - Phone:316-269-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist