Provider Demographics
NPI:1003852476
Name:WENKEL, LOIS JEAN
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:JEAN
Last Name:WENKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-8123
Mailing Address - Country:US
Mailing Address - Phone:815-653-9068
Mailing Address - Fax:815-846-0693
Practice Address - Street 1:5622 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:WONDER LAKE
Practice Address - State:IL
Practice Address - Zip Code:60097-8123
Practice Address - Country:US
Practice Address - Phone:815-653-9068
Practice Address - Fax:815-846-0693
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14600003438OtherSTATE LICENSE SPEECH PATH