Provider Demographics
NPI:1780013268
Name:WENC, RAY (HIS)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:WENC
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3796
Mailing Address - Country:US
Mailing Address - Phone:847-362-7500
Mailing Address - Fax:847-362-7506
Practice Address - Street 1:1410 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3796
Practice Address - Country:US
Practice Address - Phone:847-362-7500
Practice Address - Fax:847-362-7506
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3008237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist