Healthcare Provider Details

I. General information

NPI: 1932017209
Provider Name (Legal Business Name): MYA MICHELLE WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8281 WALKER ST
LA PALMA CA
90623-2196
US

IV. Provider business mailing address

501 N CRESCENT WAY
ANAHEIM CA
92801-5401
US

V. Phone/Fax

Practice location:
  • Phone: 410-280-1111
  • Fax:
Mailing address:
  • Phone: 714-999-3511
  • Fax: 714-535-1706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: