Provider Demographics
NPI:1548547953
Name:WEGMAN, MICHELLE ELIZABETH (MS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:WEGMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1615 STONY BATTERY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1281
Mailing Address - Country:US
Mailing Address - Phone:717-285-4843
Mailing Address - Fax:717-285-2825
Practice Address - Street 1:1615 STONY BATTERY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1281
Practice Address - Country:US
Practice Address - Phone:717-285-4843
Practice Address - Fax:717-285-2825
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional