Healthcare Provider Details

I. General information

NPI: 1215690581
Provider Name (Legal Business Name): WENDY LYNN SPECA MS, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 NORTH CENTER DRIVE BUILDING 13 SUITE 200
NORFOLK VA
23502-4008
US

IV. Provider business mailing address

2309 WHEATSTONE CT
VIRGINIA BEACH VA
23456-6047
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-0003
  • Fax:
Mailing address:
  • Phone: 757-574-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: