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General NPI Number Information
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NPI Number | 1972428225
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Entity Type | Organization
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Legal Business Name | WILD ROOTS SPEECH & LANGUAGE LLC
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 604 1ST AVE E
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City | EUREKA
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State | MT
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Zip | 59917
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Country | US
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Telephone | 316-644-2077
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 123
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City | EUREKA
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State | MT
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Zip | 59917-0123
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Country | US
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Telephone | 316-644-2077
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | AMANDA G ERICKSON
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Credential | CCC-SLP
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Telephone | 316-644-2077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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