Provider Demographics
NPI:1831436849
Name:MINOR, WENDY M J
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:M J
Last Name:MINOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:CONNELL
Mailing Address - State:WA
Mailing Address - Zip Code:99326-0829
Mailing Address - Country:US
Mailing Address - Phone:509-234-4381
Mailing Address - Fax:
Practice Address - Street 1:1001 W. CLARK STREET
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326-0829
Practice Address - Country:US
Practice Address - Phone:509-234-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2555156B235Z00000X
WA01061978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA01061978OtherAMERICAN SPEECH AND HERING ASSOCIATION
WA255156BOtherEDUCATIONAL STAFF ASSOCIATE CERTIFICATION