Provider Demographics
NPI:1073858510
Name:DELOS REYES, WENDY MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:DELOS REYES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PRINCESS ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2268
Mailing Address - Country:US
Mailing Address - Phone:703-535-7841
Mailing Address - Fax:
Practice Address - Street 1:700 PRINCESS ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2268
Practice Address - Country:US
Practice Address - Phone:703-535-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP 1257235Z00000X
VA2202007049235Z00000X
DCSLP000644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist