Provider Demographics
NPI:1053445015
Name:MCMILLAN, WENDI HOWARD (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WENDI
Middle Name:HOWARD
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 PINNACLE CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9505
Mailing Address - Country:US
Mailing Address - Phone:336-259-5668
Mailing Address - Fax:336-812-3101
Practice Address - Street 1:3001 PINNACLE CT
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9505
Practice Address - Country:US
Practice Address - Phone:336-259-5668
Practice Address - Fax:336-812-3101
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7411394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411394Medicaid