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NPI Code Detail

MEDICARE: KRISTIN R WELLS M.S.

MEDICARE: KRISTIN R WELLS M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist12695OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A008OTHERORTRICARE NW
2026648000OTHERORBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598895880
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN R WELLS M.S.
Provider Business Mailing Address
First Line : 2783 RIDGEWAY DR SE
Second Line :
City : TURNER
State : OR
Zip : 97392-9370
Country : US
Telephone Number : 541-913-4740
Fax Number : 503-362-8630
Provider Business Practice Location Address
First Line : 2783 RIDGEWAY DR SE
Second Line :
City : TURNER
State : OR
Zip : 97392-9370
Country : US
Telephone Number : 541-913-4740
Fax Number : 503-362-8630
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 05/30/2008

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Directions to “ KRISTIN R WELLS M.S.” Practice Location

Language Start Address Practice Location
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