Healthcare Provider Details

I. General information

NPI: 1578329660
Provider Name (Legal Business Name): MRS. WENDY SEWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 N HIGH ST
BUTLER MO
64730-1332
US

IV. Provider business mailing address

4153 NE COUNTY ROAD 1003
BUTLER MO
64730-9199
US

V. Phone/Fax

Practice location:
  • Phone: 660-679-6591
  • Fax:
Mailing address:
  • Phone: 660-200-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2022038171
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: