Provider Demographics
NPI:1386977163
Name:WELLS, JANE ELY (SLP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELY
Last Name:WELLS
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 1:1440 RANDOLPH AVE.
Mailing Address - Street 2:#323
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105
Mailing Address - Country:US
Mailing Address - Phone:651-699-2676
Mailing Address - Fax:
Practice Address - Street 1:1440 RANDOLPH AVE
Practice Address - Street 2:#323
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2509
Practice Address - Country:US
Practice Address - Phone:651-699-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist