Provider Demographics
NPI:1578854691
Name:JUAREZ, WENDY RAE
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:RAE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4370
Mailing Address - Country:US
Mailing Address - Phone:308-635-7415
Mailing Address - Fax:308-635-2678
Practice Address - Street 1:2821 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4370
Practice Address - Country:US
Practice Address - Phone:308-635-7415
Practice Address - Fax:308-635-2678
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE609237700000X
WY111237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist