Provider Demographics
NPI:1407156599
Name:WELLS, CINDIA KINNEY (MA-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CINDIA
Middle Name:KINNEY
Last Name:WELLS
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 NW JONQUIL PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3637
Mailing Address - Country:US
Mailing Address - Phone:541-753-2668
Mailing Address - Fax:
Practice Address - Street 1:111 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9535
Practice Address - Country:US
Practice Address - Phone:541-368-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist