Healthcare Provider Details

I. General information

NPI: 1164480489
Provider Name (Legal Business Name): VALYNDA K WELLS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 S 20TH ST
MILWAUKEE WI
53215
US

IV. Provider business mailing address

PO BOX 778789
CHICAGO IL
60677-8789
US

V. Phone/Fax

Practice location:
  • Phone: 414-897-5511
  • Fax: 414-385-7552
Mailing address:
  • Phone: 414-672-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1731
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: