Provider Demographics
NPI:1841339249
Name:WESSON, DENN B
Entity type:Individual
Prefix:
First Name:DENN
Middle Name:B
Last Name:WESSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5722
Mailing Address - Country:US
Mailing Address - Phone:209-526-3261
Mailing Address - Fax:209-526-3261
Practice Address - Street 1:1307 I ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0913
Practice Address - Country:US
Practice Address - Phone:209-524-6111
Practice Address - Fax:209-524-6177
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1348237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist