Organization
DAWN MARIE WILDERMUTH
Active
Other names
Suncoast Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN WILDERMUTH MS CCC/SLP (OWNER)
(941) 468-6701
Entity
Organization
Contact information
Practice address
411 COMMERCIAL CT, STE F, VENICE, FL 34292-1650
(941) 468-6701
(941) 485-0519
Mailing address
411 COMMERCIAL CT, STE F, VENICE, FL 34292-1650
(941) 468-6701
(941) 485-0519
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
886436500
—
FL
01
—
S1872
BC/BS
FL
Enumeration date
06/04/2007
Last updated
07/04/2008
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