Provider Demographics
NPI:1679310312
Name:WEISER, TIERNEY MARIE (MSED CCC-SLP)
Entity type:Individual
Prefix:
First Name:TIERNEY
Middle Name:MARIE
Last Name:WEISER
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3707
Mailing Address - Country:US
Mailing Address - Phone:732-703-4082
Mailing Address - Fax:
Practice Address - Street 1:101 PROSPER WAY UNIT 1112
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-3539
Practice Address - Country:US
Practice Address - Phone:732-210-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01272500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist