Provider Demographics
NPI:1174958722
Name:RUDDER-WELLS, JOY (SLP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:RUDDER-WELLS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 CLEARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-5918
Mailing Address - Country:US
Mailing Address - Phone:910-431-7092
Mailing Address - Fax:910-256-8560
Practice Address - Street 1:422 CLEARBROOK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-5918
Practice Address - Country:US
Practice Address - Phone:910-431-7092
Practice Address - Fax:910-256-8560
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist