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NPI 1710102256

NPI 1710102256 : WENDY JONES PULLIAM MS, CCC-SLP : VICTORIA, VA

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General NPI Number Information
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    NPI Number           |    1710102256
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    Entity Type          |    Individual 
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    Provider Name        |    WENDY JONES PULLIAM MS, CCC-SLP
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    04/17/2007
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    Last Update Date     |    04/03/2013
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Provider Practice Location Address
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    Address Line         |    2027 8TH ST 
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    City                 |    VICTORIA
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    State                |    VA
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    Zip                  |    23974-4506
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    Country              |    US
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    Telephone            |    434-395-2972
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    2027 8TH ST PO BOX 961
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    City                 |    VICTORIA
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    State                |    VA
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    Zip                  |    23974-4506
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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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       |    2202005151
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    License Number State |    VA
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