Basic Information
| Provider Information | |||||||||
| NPI: | 1215275987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WENZ | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 VANDER HORCK AVE. | ||||||||
| Address2: | WHEATCREST HILLS | ||||||||
| City: | BRITTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054482251 | ||||||||
| FaxNumber: | 6054485583 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 VANDER HORCK AVE. | ||||||||
| Address2: | WHEATCREST HILLS | ||||||||
| City: | BRITTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054482251 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 12146908 | SD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.