Provider Demographics
NPI:1609292358
Name:WIMS, WANDA (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:WIMS
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 VANDERGINST CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1239
Mailing Address - Country:US
Mailing Address - Phone:563-459-9208
Mailing Address - Fax:
Practice Address - Street 1:729 21ST ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5004
Practice Address - Country:US
Practice Address - Phone:563-359-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002424235Z00000X
IL146.011943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist