Provider Demographics
NPI:1336926781
Name:WELLS, DEIRDRE ANN (MS, EDD, CCC)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:MS, EDD, CCC
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:A
Other - Last Name:NOVINSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, EDD
Mailing Address - Street 1:W7544 BUCKETS LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-8892
Mailing Address - Country:US
Mailing Address - Phone:651-783-2368
Mailing Address - Fax:
Practice Address - Street 1:725 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3399
Practice Address - Country:US
Practice Address - Phone:715-723-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI673-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist