Provider Demographics
NPI:1679738082
Name:IDWI, INC
Entity Type:Organization
Organization Name:IDWI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JOE'L
Authorized Official - Middle Name:EDINGTON
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:918-637-5114
Mailing Address - Street 1:2864 SW LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-6843
Mailing Address - Country:US
Mailing Address - Phone:918-637-7912
Mailing Address - Fax:918-465-3095
Practice Address - Street 1:2864 SW LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-6843
Practice Address - Country:US
Practice Address - Phone:918-637-5114
Practice Address - Fax:918-465-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty