Provider Demographics
NPI:1215263280
Name:STEPHENS, WENDIE (SLP)
Entity type:Individual
Prefix:MS
First Name:WENDIE
Middle Name:
Last Name:STEPHENS
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 1:2128 E GANO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-1345
Mailing Address - Country:US
Mailing Address - Phone:314-231-9608
Mailing Address - Fax:
Practice Address - Street 1:2128 E GANO AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-1345
Practice Address - Country:US
Practice Address - Phone:314-231-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO235Z00000XMedicaid