Provider Demographics
NPI:1942646922
Name:CRESPO, WENDY LOU (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LOU
Last Name:CRESPO
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26090 OAK LEAF TRL
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8478
Mailing Address - Country:US
Mailing Address - Phone:952-240-3403
Mailing Address - Fax:
Practice Address - Street 1:1017 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7517
Practice Address - Country:US
Practice Address - Phone:952-746-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5921231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist