Healthcare Provider Details

I. General information

NPI: 1942013818
Provider Name (Legal Business Name): WILDFLOWER PEDIATRIC PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 BLAZER PARKWAY STE 137
DUBLIN OH
43017-3562
US

IV. Provider business mailing address

5650 BLAZER PARKWAY STE 137
DUBLIN OH
43017-3562
US

V. Phone/Fax

Practice location:
  • Phone: 614-333-8442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JESSICA GRABER
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD, BCBA-D, COBA
Phone: 614-333-8442