Provider Demographics
NPI:1457886855
Name:ECHOLS, WENDY (MS CCC-SLP, IBCLC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:MS CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 S RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5242
Mailing Address - Country:US
Mailing Address - Phone:641-420-9781
Mailing Address - Fax:
Practice Address - Street 1:101 VILLA WAY
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-2800
Practice Address - Country:US
Practice Address - Phone:907-201-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-314690174N00000X
IA078716235Z00000X
WYSP-1009235Z00000X
CASP34964235Z00000X
AK205030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN