Doctor Name: | SUE ANNE WAKELAND |
NPI Number: | 1386841997 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MED CCC SLP |
License Number: | 5319199-4102 |
Business Practice Address: | 25 Alpine Ave Pleasant Grove, UT - 840623511 |
Business Phone Number: | 8017853568 |
Business Fax Number: | |
Mailing Address: | 771 E 800 N, PLEASANT GROVE |
State: | UT |
Postal Code: | 840621957 |
Phone Number: | 8017965385 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 5319199-4102 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |