Provider Demographics
NPI:1902816440
Name:TOOKER, WENDY LEE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:TOOKER
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 1:4540 SAMARA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5245
Mailing Address - Country:US
Mailing Address - Phone:505-897-3271
Mailing Address - Fax:505-897-3271
Practice Address - Street 1:4540 SAMARA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5245
Practice Address - Country:US
Practice Address - Phone:505-897-3271
Practice Address - Fax:505-897-3271
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000A0363Medicaid