Provider Demographics
NPI:1841392917
Name:WREN, MALEIKA (SLP)
Entity Type:Individual
Prefix:
First Name:MALEIKA
Middle Name:
Last Name:WREN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MALEIKA
Other - Middle Name:ANN
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:409 RUNNELS ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2529
Mailing Address - Country:US
Mailing Address - Phone:432-264-2650
Mailing Address - Fax:432-268-9897
Practice Address - Street 1:114 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-4552
Practice Address - Country:US
Practice Address - Phone:800-852-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist