Provider Demographics
NPI:1225309396
Name:WELLS, AMBER M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:WELLS
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 1:3825 CANDY LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-7040
Mailing Address - Country:US
Mailing Address - Phone:432-385-8320
Mailing Address - Fax:
Practice Address - Street 1:808 TOWER DR STE 7
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4243
Practice Address - Country:US
Practice Address - Phone:432-335-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist