Healthcare Provider Details

I. General information

NPI: 1811629249
Provider Name (Legal Business Name): BRAELYN NICOLE WENCE MS CCC-SLP CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N GRAHAM RD
FRANKLIN IN
46131-1277
US

IV. Provider business mailing address

806 KELLY PASS
GREENWOOD IN
46143-5572
US

V. Phone/Fax

Practice location:
  • Phone: 812-343-2797
  • Fax:
Mailing address:
  • Phone: 812-240-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number46004097A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: