Provider Demographics
NPI:1922807171
Name:WILDFLOWER THERAPY
Entity type:Organization
Organization Name:WILDFLOWER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICAELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:989-751-5995
Mailing Address - Street 1:3323 GERNADA DR
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1912
Mailing Address - Country:US
Mailing Address - Phone:989-751-5995
Mailing Address - Fax:
Practice Address - Street 1:3323 GERNADA DR
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1912
Practice Address - Country:US
Practice Address - Phone:989-751-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty