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Organization
WISHFLOWER SPEECH THERAPY
Active
Organization
WISHFLOWER SPEECH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA PROVOST MS, CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(715) 990-9064
Entity
Organization
Contact information
Practice address
211 W 4TH ST, WASHBURN, WI 54891-9328
(651) 600-5922
Mailing address
PO BOX 151, WASHBURN, WI 54891-0151
(651) 600-5922
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/16/2024
Last updated
08/16/2024
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