Provider Demographics
NPI:1932588191
Name:FLEWELLING, WAYNE (CCC/SP)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:FLEWELLING
Suffix:
Gender:M
Credentials:CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HUDSON TER
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05763-9438
Mailing Address - Country:US
Mailing Address - Phone:802-779-3539
Mailing Address - Fax:
Practice Address - Street 1:142 HUDSON TER
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:VT
Practice Address - Zip Code:05763-9438
Practice Address - Country:US
Practice Address - Phone:802-779-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8011026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist