Provider Demographics
NPI:1851162176
Name:WONDERFULLY MADE THERAPIES, PLLC.
Entity Type:Organization
Organization Name:WONDERFULLY MADE THERAPIES, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:214-949-5559
Mailing Address - Street 1:605 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-8219
Mailing Address - Country:US
Mailing Address - Phone:214-949-5559
Mailing Address - Fax:
Practice Address - Street 1:107 S GAINES ST STE 104
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4612
Practice Address - Country:US
Practice Address - Phone:214-949-5559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty