Healthcare Provider Details

I. General information

NPI: 1457547556
Provider Name (Legal Business Name): WANDA L CAREY CDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29302 BIERI RD
CALIFORNIA MO
65018-3320
US

IV. Provider business mailing address

29302 BIERI RD
CALIFORNIA MO
65018-3320
US

V. Phone/Fax

Practice location:
  • Phone: 573-796-8253
  • Fax: 573-796-3921
Mailing address:
  • Phone: 573-796-8253
  • Fax: 573-796-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: