Provider Demographics
NPI:1972665750
Name:GAILLARD, WENDELL ELLIOTT III (MS)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:ELLIOTT
Last Name:GAILLARD
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6601
Mailing Address - Country:US
Mailing Address - Phone:334-887-8222
Mailing Address - Fax:
Practice Address - Street 1:1819 PEPPERELL PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5475
Practice Address - Country:US
Practice Address - Phone:334-741-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2201OtherALABAMA BOARD CERTIFICATI