Provider Demographics
NPI:1194181545
Name:WETTERER, PAULA (MS, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:WETTERER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3928
Mailing Address - Country:US
Mailing Address - Phone:505-454-5700
Mailing Address - Fax:
Practice Address - Street 1:901 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3928
Practice Address - Country:US
Practice Address - Phone:505-454-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist