Healthcare Provider Details

I. General information

NPI: 1902466873
Provider Name (Legal Business Name): ARIC WORMINGTON M.S.,CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9047 W GREENFIELD AVE
WEST ALLIS WI
53214-2800
US

IV. Provider business mailing address

3380 HOLLYWOOD LN
BROOKFIELD WI
53045-2547
US

V. Phone/Fax

Practice location:
  • Phone: 414-453-9290
  • Fax:
Mailing address:
  • Phone: 414-745-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2054-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: