Healthcare Provider Details

I. General information

NPI: 1013835313
Provider Name (Legal Business Name): WILDFLOWER THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17926 W HAMMOND ST
GOODYEAR AZ
85338-7524
US

IV. Provider business mailing address

17926 W HAMMOND ST
GOODYEAR AZ
85338-7524
US

V. Phone/Fax

Practice location:
  • Phone: 623-238-5075
  • Fax:
Mailing address:
  • Phone: 623-238-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ESTEFANIA CHAVEZ
Title or Position: FOUNDER/CEO
Credential: CCC-SLP
Phone: 623-238-5075