Provider Demographics
NPI:1043491863
Name:RIVERA, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 E TYLER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7212
Mailing Address - Country:US
Mailing Address - Phone:956-440-0580
Mailing Address - Fax:
Practice Address - Street 1:2010 S CYNTHIA ST STE 107
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-994-9501
Practice Address - Fax:956-994-9511
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199801235Z00000X
TX19801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87459TMedicare Oscar/Certification