Provider Demographics
NPI:1811201163
Name:BERRETT, WENDY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BERRETT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 W BINGHAM RIM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1442
Mailing Address - Country:US
Mailing Address - Phone:801-412-1034
Mailing Address - Fax:
Practice Address - Street 1:5325 W BINGHAM RIM RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-1442
Practice Address - Country:US
Practice Address - Phone:801-412-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6045613-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist