Provider Demographics
NPI:1285183145
Name:WIVELL, WILLIAM ELDRED JR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELDRED
Last Name:WIVELL
Suffix:JR
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 1:4429 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2006
Mailing Address - Country:US
Mailing Address - Phone:520-327-1756
Mailing Address - Fax:520-327-3575
Practice Address - Street 1:4429 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2006
Practice Address - Country:US
Practice Address - Phone:520-327-1756
Practice Address - Fax:520-327-3575
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD869237700000X
AZ869237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist