Dawn Elizabeth Wetzel, MAT CCC
Individual provider Active NPI Speech-Language Pathologist · West Lafayette, IN
NPI 1295915916 · NPPES record last updated Nov 17, 2009
Key facts
- NPI
- 1295915916
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 22001747A (IN)
- Practice address
- 500 Oval Drive
Heavilon Hall G34D
West Lafayette, IN 47907-2038 - Phone
- (765) 494-3816
- Fax
- (765) 494-0771
- NPI assigned
- Nov 9, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091001000087 | IN | Practitioner - Qualified Speech Language Pathologist | 0244316404 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22001747 | IN | MD | Speech-Language Pathologist |
| 22001747A | IN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iu Health Medical Group, LLC | Current |
Accepting new patients | |
| Purdue University | Past | Accepting new patients |
Locations
1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754
2600 Greenbush St
Lafayette, IN 47904
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22001747 | IN | |
| Speech-Language Pathologist | 235Z00000X | 22001747A | IN | Yes |
Addresses
Primary practice location
500 Oval Drive
Heavilon Hall G34D
West Lafayette, IN 47907-2038
Mailing address
601 Stadium Mall Drive
West Lafayette, IN 47907-2052
Phone (765) 496-1927
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000553114 | Other | IN | ANTHEM |
| 200891420 | Medicaid | IN |
Other providers in West Lafayette, IN
- West Side Rehabilitation Inc
- Kayla West
- Karen Elaine Westfall Collier
- Westminster Village West Lafayette, Inc
- Jason Douglas Wethington
- Johnetta Whitmire
- Amanda Brooke Wichert
- Rachel Wichlinski
- Heather L Wicker
- Wickshire West Lafayette Opco LLC
All providers in West Lafayette, IN · Speech-Language Pathologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.