Provider Demographics
NPI:1386423879
Name:HUGHES-WANCEWICZ, VIVIAN (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:HUGHES-WANCEWICZ
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N DUBOIS RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-8589
Mailing Address - Country:US
Mailing Address - Phone:318-348-5463
Mailing Address - Fax:
Practice Address - Street 1:1500 JANE ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-1544
Practice Address - Country:US
Practice Address - Phone:337-365-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist