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General NPI Number Information
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NPI Number | 1477857803
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Entity Type | Organization
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Legal Business Name | WENDY TOOKER
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 400 CALLE DE WENCES
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City | LOS LUNAS
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State | NM
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Zip | 87031-9300
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Country | US
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Telephone | 505-269-4753
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Fax | 928-779-2361
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Provider Business Mailing Address
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Address Line | 505 W FIR AVE
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1308
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Country | US
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Telephone | 505-269-4753
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Fax | 928-779-2361
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Authorized Official
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Title or Position | OWNER
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Name | WENDY TOOKER
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Credential | MS, CCC-SLP
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Telephone | 505-269-4753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 3850
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License Number State | NM
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