Provider Demographics
NPI:1306675244
Name:WILLIS, WREN
Entity type:Individual
Prefix:
First Name:WREN
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WAYNESVILLE PLZ # 1009
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-575-5874
Practice Address - Street 1:89 WAYNESVILLE PLZ # 1009
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-2990
Practice Address - Country:US
Practice Address - Phone:828-222-3824
Practice Address - Fax:828-575-5874
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist