Provider Demographics
NPI:1578215125
Name:WHEELER, KENDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDA
Middle Name:
Last Name:WHEELER
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 1:3130 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9488
Mailing Address - Country:US
Mailing Address - Phone:903-737-2031
Mailing Address - Fax:903-669-0159
Practice Address - Street 1:3130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9488
Practice Address - Country:US
Practice Address - Phone:903-737-2031
Practice Address - Fax:903-669-0159
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist