Provider Demographics
NPI:1801198262
Name:WILLDEN, ANONA MULLINS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANONA
Middle Name:MULLINS
Last Name:WILLDEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-1357
Mailing Address - Country:US
Mailing Address - Phone:435-851-6939
Mailing Address - Fax:
Practice Address - Street 1:176 W UNION ST
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642-1357
Practice Address - Country:US
Practice Address - Phone:435-851-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7070640-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist