Provider Demographics
NPI:1841980125
Name:WILDFLOWER SPEECH AND LANGUAGE THERAPY, LLC
Entity type:Organization
Organization Name:WILDFLOWER SPEECH AND LANGUAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:256-770-9643
Mailing Address - Street 1:1400 COMMERCE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-9452
Mailing Address - Country:US
Mailing Address - Phone:256-770-9643
Mailing Address - Fax:256-298-9781
Practice Address - Street 1:1400 COMMERCE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-9452
Practice Address - Country:US
Practice Address - Phone:256-770-9643
Practice Address - Fax:256-298-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty