Provider Demographics
NPI:1215112735
Name:CARRUTHERS, WENDELYN N (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WENDELYN
Middle Name:N
Last Name:CARRUTHERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:WENDELYN
Other - Middle Name:N
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:14 ASHTON STREET
Mailing Address - Street 2:APT. 2
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124
Mailing Address - Country:US
Mailing Address - Phone:617-635-8623
Mailing Address - Fax:617-635-9947
Practice Address - Street 1:THOM BOSTON METRO EARLY INTERVENTION
Practice Address - Street 2:555 AMORY STREET
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-383-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA413579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist