Provider Demographics
NPI:1952795718
Name:WILLS, PAULINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:FRAEMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1212 PAIUTE TRL
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4061
Mailing Address - Country:US
Mailing Address - Phone:575-430-9124
Mailing Address - Fax:
Practice Address - Street 1:10051 FOXES WAY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3458
Practice Address - Country:US
Practice Address - Phone:540-775-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist