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General NPI Number Information
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NPI Number | 1851162176
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Entity Type | Organization
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Legal Business Name | WONDERFULLY MADE THERAPIES, PLLC.
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 107 S GAINES ST STE 104
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City | ENNIS
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State | TX
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Zip | 75119-4612
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Country | US
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Telephone | 214-949-5559
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Fax |
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Provider Business Mailing Address
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Address Line | 605 WILLIAMSBURG DR
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City | ENNIS
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State | TX
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Zip | 75119-8219
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Country | US
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Telephone | 214-949-5559
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/OWNER
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Name | DARLA DIANE GARDNER
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Credential | SLP
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Telephone | 214-949-5559
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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 |
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License Number State |
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