Provider Demographics
NPI:1275094070
Name:ROBERTS, WENDY JOAN
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JOAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:JOAN
Other - Last Name:NEUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16220 SCIENTIFIC
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4349
Mailing Address - Country:US
Mailing Address - Phone:949-654-2424
Mailing Address - Fax:
Practice Address - Street 1:16220 SCIENTIFIC
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4349
Practice Address - Country:US
Practice Address - Phone:949-654-2424
Practice Address - Fax:949-654-2428
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP7688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist