Provider Demographics
NPI:1972878825
Name:WIGGLY KIDLETS
Entity type:Organization
Organization Name:WIGGLY KIDLETS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAFFNEY
Authorized Official - Middle Name:VEALS
Authorized Official - Last Name:OBARE
Authorized Official - Suffix:
Authorized Official - Credentials:SLPA
Authorized Official - Phone:956-371-0817
Mailing Address - Street 1:601 TRENTON RD
Mailing Address - Street 2:STE D169
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2107
Mailing Address - Country:US
Mailing Address - Phone:956-371-0817
Mailing Address - Fax:
Practice Address - Street 1:601 TRENTON RD
Practice Address - Street 2:STE D169
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2107
Practice Address - Country:US
Practice Address - Phone:956-371-0817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337082355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty