Provider Demographics
NPI:1740657956
Name:WELLS, CHERYL (SLP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 LYNDALE DR
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2143
Mailing Address - Country:US
Mailing Address - Phone:682-298-4892
Mailing Address - Fax:
Practice Address - Street 1:6913 LYNDALE DR
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2143
Practice Address - Country:US
Practice Address - Phone:682-298-4892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10780OtherSPEECH LANGUAGE THERAPIST