Provider Demographics
NPI:1558771980
Name:WELLS, JASON J
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:J
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7851 ENON DR
Mailing Address - Street 2:HOLLINS COMMUNICATIONS RESEARCH INSTITUTE
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-1515
Mailing Address - Country:US
Mailing Address - Phone:540-265-5650
Mailing Address - Fax:540-265-0386
Practice Address - Street 1:7851 ENON DR
Practice Address - Street 2:HOLLINS COMMUNICATIONS RESEARCH INSTITUTE
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-1515
Practice Address - Country:US
Practice Address - Phone:540-265-5650
Practice Address - Fax:540-265-0386
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001916237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist