Provider Demographics
NPI:1225214901
Name:TROTTER, WENDY L (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:L
Last Name:TROTTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 E EMPIRE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3630
Mailing Address - Country:US
Mailing Address - Phone:309-663-8275
Mailing Address - Fax:309-662-7872
Practice Address - Street 1:2404 E EMPIRE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3630
Practice Address - Country:US
Practice Address - Phone:309-663-8275
Practice Address - Fax:309-662-7872
Is Sole Proprietor?:No
Enumeration Date:2008-01-13
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7263235Z00000X
IL146.004920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist