MEDICARE: WILDFLOWER THERAPY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1265059620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDFLOWER THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	225 CHACO CANYON DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-1987
Country	:	US
Telephone Number	:	907-978-5430
Fax Number	:	725-220-6404

Provider Business Practice Location Address
First Line	:	2780 S JONES BLVD # 200-3222
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:	907-978-5430
Fax Number	:	725-220-6404

Authorized Official
Title or Position	:	OWNER/SPEECH LANGUAGE PATHOLOGIST
Name	:	MRS. JENNIFER MEGAN BENNETT
Credential	:	MS CCC-SLP
Telephone Number	:	907-978-5430

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	06/12/2023

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Directions to “WILDFLOWER THERAPY SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

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