Organization
WILLISTON CENTER FOR PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANY K VICKERS CCC-SLP (BUSINESS OWNER)
(701) 572-5974
Entity
Organization
Contact information
Practice address
1106 2ND ST W, WILLISTON, ND 58801-5804
(701) 572-5974
(866) 279-5137
Mailing address
205 11TH ST E, WILLISTON, ND 58801-5445
(701) 572-5974
(866) 279-5137
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1036
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56183
—
ND
Enumeration date
11/28/2012
Last updated
11/26/2013
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