Provider Demographics
NPI:1790494664
Name:WONDER WILD SPEECH AND LANGUAGE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:WONDER WILD SPEECH AND LANGUAGE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-704-9492
Mailing Address - Street 1:913 N CHURCH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:913 N CHURCH ST APT 208
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4521
Practice Address - Country:US
Practice Address - Phone:715-704-9492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech