| NPI | 1184204208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNINE THERESE WILMOT Manager/Provider 702-703-6408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2024-01-04 |