Individual
BRANDY MORGAN WHILDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
619 S MARION AVE FL 5808, LAKE CITY, FL 32025-5808
(386) 697-5867
Mailing address
13604 SE COUNTY ROAD 132, JASPER, FL 32052-4062
(386) 697-5867
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA17505
FL
235Z00000X
Speech-Language Pathologist
SZ8928
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508815630
—
FL
Enumeration date
11/06/2018
Last updated
02/22/2023
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