Provider Demographics
NPI:1811629249
Name:WENCE, BRAELYN NICOLE
Entity Type:Individual
Prefix:
First Name:BRAELYN
Middle Name:NICOLE
Last Name:WENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N MERIDIAN ST APT 507
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-7705
Mailing Address - Country:US
Mailing Address - Phone:812-240-1090
Mailing Address - Fax:
Practice Address - Street 1:1176 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1251
Practice Address - Country:US
Practice Address - Phone:812-343-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004097A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist