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NPI Code Detail

MEDICARE: DENISE WINGO M.S. CCC-SLP

MEDICARE: DENISE WINGO M.S. CCC-SLP
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 Pathologist2013017261MO

General Provider Information

NPI Number : 1851654511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE WINGO M.S. CCC-SLP
Provider Business Mailing Address
First Line : 638 S MAPLE AVE
Second Line :
City : REPUBLIC
State : MO
Zip : 65738-2219
Country : US
Telephone Number : 417-818-8011
Fax Number :
Provider Business Practice Location Address
First Line : 1700 S HUDSON AVE
Second Line :
City : AURORA
State : MO
Zip : 65605-2717
Country : US
Telephone Number : 417-818-8011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2012
Last Update Date : 12/11/2016

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Directions to “ DENISE WINGO M.S. CCC-SLP” Practice Location

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