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NPI Code Detail

MEDICARE: DAWN WILDERMUTH MS CCC/SLP

MEDICARE: DAWN WILDERMUTH MS CCC/SLP
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
1235Z00000XSpeech-Language PathologistSA0000934FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568556033
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN WILDERMUTH MS CCC/SLP
Provider Business Mailing Address
First Line : 1210 LEXINGTON DR.
Second Line :
City : VENICE
State : FL
Zip : 34292
Country : US
Telephone Number : 941-468-6701
Fax Number :
Provider Business Practice Location Address
First Line : 2574 COMMERCE PKWY
Second Line :
City : NORTH PORT
State : FL
Zip : 34289-9334
Country : US
Telephone Number : 941-485-0121
Fax Number : 941-485-0591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 12/26/2023

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Directions to “ DAWN WILDERMUTH MS CCC/SLP” Practice Location

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