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Organization
KIDS FIRST THERAPY, LLC
Active
Organization
KIDS FIRST THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER WOLLAN (SPEECH-LANGUAGE PATHOLOGIST)
(701) 866-9529
Entity
Organization
Contact information
Practice address
1102 7TH ST S, FARGO, ND 58103-2712
(701) 866-9529
Mailing address
1102 7TH ST S, FARGO, ND 58103-2712
(701) 866-9529
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
955
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861690752
BLUE CROSS AND BLUE SHIELD
—
05
—
1861690752
—
ND
Enumeration date
12/15/2014
Last updated
12/15/2014
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