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General NPI Number Information
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NPI Number | 1942013818
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Entity Type | Organization
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Legal Business Name | WILDFLOWER PEDIATRIC PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 5650 BLAZER PARKWAY STE 137
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City | DUBLIN
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State | OH
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Zip | 43017-3562
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Country | US
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Telephone | 614-333-8442
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Fax |
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Provider Business Mailing Address
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Address Line | 5650 BLAZER PARKWAY STE 137
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City | DUBLIN
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State | OH
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Zip | 43017-3562
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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 | LICENSED PSYCHOLOGIST
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Name | DR. JESSICA GRABER
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Credential | PHD, BCBA-D, COBA
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Telephone | 614-333-8442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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