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General NPI Number Information
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NPI Number | 1427302207
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Entity Type | Organization
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Legal Business Name | WILKINSON BRODEN THERAPY INNOVATIONS, LLC
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1118 THE MEADOWS PKWY
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City | DESOTO
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State | TX
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Zip | 75115-3518
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Country | US
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Telephone | 214-687-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 THE MEADOWS PKWY
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City | DESOTO
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State | TX
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Zip | 75115-3518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DONNA WILKINSON BRODEN
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Credential | M.A., CCC-SLP
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Telephone | 214-392-5776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1842
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License Number State | TX
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