| NPI | 1982116273 |
|---|---|
| Former Name | ALYSSA WILD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 518179) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WI 4494-154) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2022-04-29 |