Provider Demographics
NPI:1952690869
Name:WELLENZOHN, MARY K (MS SLP CCC-L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:WELLENZOHN
Suffix:
Gender:F
Credentials:MS SLP CCC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1751
Mailing Address - Country:US
Mailing Address - Phone:716-626-8563
Mailing Address - Fax:
Practice Address - Street 1:1595 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1751
Practice Address - Country:US
Practice Address - Phone:716-626-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 008080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist