Provider Demographics
NPI:1093022501
Name:WULLNER, EVELYN NADINE
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:NADINE
Last Name:WULLNER
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 1:30 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:S GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2938
Mailing Address - Country:US
Mailing Address - Phone:925-366-4214
Mailing Address - Fax:
Practice Address - Street 1:30 ASPEN DR
Practice Address - Street 2:
Practice Address - City:S GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2938
Practice Address - Country:US
Practice Address - Phone:925-366-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist