| NPI | 1669883195 |
|---|---|
| Other Name | STACY L WILD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 10821) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 023699) |
| 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0000806) | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-07-02 |