Provider Demographics
NPI:1922739895
Name:WELLS, BRANDY (HIS)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 W MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1704
Mailing Address - Country:US
Mailing Address - Phone:317-742-0212
Mailing Address - Fax:
Practice Address - Street 1:52 E MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1857
Practice Address - Country:US
Practice Address - Phone:317-742-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001564A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist