Healthcare Provider Details

I. General information

NPI: 1225816085
Provider Name (Legal Business Name): WILDFLOWER SPEECH AND LANGUAGE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 HOGBACK RD STE 7A
ANN ARBOR MI
48105-8800
US

IV. Provider business mailing address

213 W MADISON ST
ANN ARBOR MI
48103-4921
US

V. Phone/Fax

Practice location:
  • Phone: 248-860-1155
  • Fax:
Mailing address:
  • Phone: 248-860-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BETH ANN BENKO
Title or Position: SPEECH-LANGUAGE PATHOLOGIST, OWNER
Credential: MS CCC-SLP
Phone: 248-860-1155