Organization
WILDER LANGUAGE AND LEARNING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISA M WILDER MA SLP/CCC (OWNER/ SPEECH LANGUAGE PATH)
(303) 818-0508
Entity
Organization
Contact information
Practice address
3825 MONTEREY PLACE, BOULDER, CO 80301
(303) 818-0508
Mailing address
3825 MONTEREY PLACE, BOULDER, CO 80301
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12119008
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861718033
—
AZ
05
—
1861718033
—
CO
Enumeration date
02/05/2014
Last updated
02/05/2014
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