Provider Demographics
NPI:1083760235
Name:DUDLEY, WENDY SUE
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE
Last Name:DUDLEY
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 1:15364 CRESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-9159
Mailing Address - Country:US
Mailing Address - Phone:970-522-8865
Mailing Address - Fax:970-522-3395
Practice Address - Street 1:15364 CRESTVIEW LN
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9159
Practice Address - Country:US
Practice Address - Phone:970-522-8865
Practice Address - Fax:970-522-3395
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0251211231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78976332Medicaid