Provider Demographics
NPI:1174000111
Name:AVOLIO, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:AVOLIO
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 1:2320 RISING GLEN WAY APT 106
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2088
Mailing Address - Country:US
Mailing Address - Phone:831-594-2885
Mailing Address - Fax:
Practice Address - Street 1:2320 RISING GLEN WAY APT 106
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2088
Practice Address - Country:US
Practice Address - Phone:831-594-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist