Provider Demographics
NPI:1336418433
Name:WELLS, MARY ELIZABETH (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:WELLS
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 YACHT CLUB DR
Mailing Address - Street 2:# 5
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7193
Mailing Address - Country:US
Mailing Address - Phone:251-625-1134
Mailing Address - Fax:251-342-2060
Practice Address - Street 1:4 YACHT CLUB DR
Practice Address - Street 2:# 5
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7193
Practice Address - Country:US
Practice Address - Phone:251-625-1134
Practice Address - Fax:251-342-2060
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist