Basic Information
| Provider Information | |||||||||
| NPI: | 1104439637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WENNER | ||||||||
| FirstName: | CHELSEY | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 284 | ||||||||
| Address2: | |||||||||
| City: | CYGNET | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434130284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195752075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5800 PARK CENTER CT STE C | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436150710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197248368 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2020 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | A.02269 | OH | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.