MEDICARE: DEIRDRE ANN WELLS MS, EDD, CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	673-154	WI

General Provider Information

NPI Number	:	1336926781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE ANN WELLS MS, EDD, CCC

Provider Business Mailing Address
First Line	:	W7544 BUCKETS LN
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-8892
Country	:	US
Telephone Number	:	651-783-2368
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 W PARK AVE
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-3399
Country	:	US
Telephone Number	:	715-723-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	02/22/2024

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