Provider Demographics
NPI:1629490990
Name:VIAENE-WICK, DEANA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:VIAENE-WICK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45159 VINE CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5515
Mailing Address - Country:US
Mailing Address - Phone:951-553-3558
Mailing Address - Fax:
Practice Address - Street 1:45159 VINE CLIFF ST
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5515
Practice Address - Country:US
Practice Address - Phone:951-553-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 11104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist