Provider Demographics
NPI:1730746868
Name:WELLS, JASON C (HAD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:WELLS
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MILFORD ST APT B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7099
Mailing Address - Country:US
Mailing Address - Phone:410-546-4327
Mailing Address - Fax:
Practice Address - Street 1:209 MILFORD ST APT B
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7099
Practice Address - Country:US
Practice Address - Phone:410-546-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02806237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty