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Individual
MRS. DEANA SUSAN WAMBOLDT
Active
Individual
MRS. DEANA SUSAN WAMBOLDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA 5673
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12049301
ASHA LICENSE #
FL
01
—
SA 5673
STATE OF FLORIDA LICENSE
—
Enumeration date
05/02/2007
Last updated
07/09/2007
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