Provider Demographics
NPI:1538259858
Name:WAYMAN, JEAN SHELTON (MS, CCC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:SHELTON
Last Name:WAYMAN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MECCA RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7233
Mailing Address - Country:US
Mailing Address - Phone:254-756-2337
Mailing Address - Fax:
Practice Address - Street 1:2124 N 25TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3317
Practice Address - Country:US
Practice Address - Phone:254-235-2430
Practice Address - Fax:254-235-2434
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist