| Doctor Name: | TOMMI ANN WILDE |
| NPI Number: | 1003174236 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | SA8222 |
| Business Practice Address: | 2900 Charlevoix Dr Se Suite 200 Grand Rapids, MI - 495467085 |
| Business Phone Number: | 8006848049 |
| Business Fax Number: | |
| Mailing Address: | 23 Pied Ct, ORLANDO |
| State: | FL |
| Postal Code: | 328287132 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/25/2012 |
| NPI Last Update Date: | 04/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA8222 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |