Provider Demographics
NPI:1225816085
Name:WILDFLOWER SPEECH AND LANGUAGE THERAPY PLLC
Entity Type:Organization
Organization Name:WILDFLOWER SPEECH AND LANGUAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:248-860-1155
Mailing Address - Street 1:213 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4921
Mailing Address - Country:US
Mailing Address - Phone:248-860-1155
Mailing Address - Fax:
Practice Address - Street 1:2010 HOGBACK RD STE 7A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-8800
Practice Address - Country:US
Practice Address - Phone:248-860-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty