Individual
MS. ANDREA MICHELLE WENNERSTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1450 ENCINA RD, SANTA FE, NM 87505-4726
(505) 983-6829
Mailing address
1562 CORTE LA CANADA, SANTA FE, NM 87501-2359
(505) 670-7074
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3936
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65389018
—
NM
Enumeration date
02/08/2007
Last updated
11/18/2011
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