Provider Demographics
NPI:1073714291
Name:DETERS, WENDY BAN (MS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:BAN
Last Name:DETERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-5719
Mailing Address - Country:US
Mailing Address - Phone:773-678-1652
Mailing Address - Fax:
Practice Address - Street 1:180 HANSEN CT
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1121
Practice Address - Country:US
Practice Address - Phone:630-595-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist