Provider Demographics
NPI:1134538788
Name:GILLEN, WENDY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GILLEN
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 1:169 LINCOLN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4640
Mailing Address - Country:US
Mailing Address - Phone:617-840-5445
Mailing Address - Fax:781-875-3060
Practice Address - Street 1:169 LINCOLN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4640
Practice Address - Country:US
Practice Address - Phone:617-840-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist