Provider Demographics
NPI:1689819252
Name:WIBERG, WENDY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:WIBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 OLD ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-1064
Mailing Address - Country:US
Mailing Address - Phone:978-404-9321
Mailing Address - Fax:978-664-5884
Practice Address - Street 1:89 OLD ANDOVER RD
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1064
Practice Address - Country:US
Practice Address - Phone:978-404-9321
Practice Address - Fax:978-664-5884
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1908-W235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist