Basic Information
| Provider Information | |||||||||
| NPI: | 1114152600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEIHING | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 FOREST AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041031884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077975753 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1250 FOREST AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041031884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077975753 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 0534 | KY | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 1028 | KY | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | AP2652 | ME | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.