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NPI Code Detail

MEDICARE: WILDFLOWER THERAPY SERVICES, LLC

MEDICARE: WILDFLOWER THERAPY SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist
2235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1265059620
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILDFLOWER THERAPY SERVICES, LLC
Provider Business Mailing Address
First Line : 225 CHACO CANYON DR
Second Line :
City : HENDERSON
State : NV
Zip : 89074-1987
Country : US
Telephone Number : 907-978-5430
Fax Number : 725-220-6404
Provider Business Practice Location Address
First Line : 2780 S JONES BLVD # 200-3222
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-5628
Country : US
Telephone Number : 907-978-5430
Fax Number : 725-220-6404
Authorized Official
Title or Position : OWNER/SPEECH LANGUAGE PATHOLOGIST
Name : MRS. JENNIFER MEGAN BENNETT
Credential : MS CCC-SLP
Telephone Number : 907-978-5430
Provider Enumeration Date : 07/01/2020
Last Update Date : 06/12/2023

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Directions to “WILDFLOWER THERAPY SERVICES, LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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