Provider Demographics
NPI:1851519896
Name:WINGATE, RAEDEEN ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAEDEEN
Middle Name:ANN
Last Name:WINGATE
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 1:208 W SHADY SHORES RD
Mailing Address - Street 2:
Mailing Address - City:SHADY SHORES
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5037
Mailing Address - Country:US
Mailing Address - Phone:940-321-5585
Mailing Address - Fax:
Practice Address - Street 1:907 WEST SYCAMORE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76203
Practice Address - Country:US
Practice Address - Phone:940-369-7497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist