Provider Demographics
NPI:1457423592
Name:WELLS, JENNIFER MICHELLE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2524 E 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4584
Mailing Address - Country:US
Mailing Address - Phone:509-939-7092
Mailing Address - Fax:
Practice Address - Street 1:8502 N NEVADA ST
Practice Address - Street 2:#2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7395
Practice Address - Country:US
Practice Address - Phone:509-487-2958
Practice Address - Fax:509-487-3025
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist