Individual
SUE ANNE WAKELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED CCC SLP
Contact information
Practice address
25 ALPINE AVE, PLEASANT GROVE, UT 84062-3511
(801) 785-3568
Mailing address
771 E 800 N, PLEASANT GROVE, UT 84062-1957
(801) 796-5385
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5319199-4102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870574059031
—
UT
Enumeration date
06/27/2007
Last updated
07/08/2007
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