Provider Demographics
NPI:1154078137
Name:CANTILLON, WENDY (SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CANTILLON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5265
Mailing Address - Country:US
Mailing Address - Phone:978-771-2126
Mailing Address - Fax:
Practice Address - Street 1:201 JACK LOVERING DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4922
Practice Address - Country:US
Practice Address - Phone:603-628-6247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist