Healthcare Provider Details

I. General information

NPI: 1073759122
Provider Name (Legal Business Name): VANESSA NOEL WINKLER M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILDCAT DR
NEW LONDON OH
44851-9262
US

IV. Provider business mailing address

1 WILDCAT DR
NEW LONDON OH
44851-9262
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-1586
  • Fax:
Mailing address:
  • Phone: 419-929-1586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9418
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: