Provider Demographics
NPI:1609347921
Name:WYMER, MARCY DALENE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:DALENE
Last Name:WYMER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:DALENE
Other - Last Name:WYMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:701 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1292
Mailing Address - Country:US
Mailing Address - Phone:319-398-6881
Mailing Address - Fax:319-369-4577
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1292
Practice Address - Country:US
Practice Address - Phone:319-398-6881
Practice Address - Fax:319-369-4577
Is Sole Proprietor?:No
Enumeration Date:2018-12-13
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist