| Organization Name: | WILLISTON CENTER FOR PEDIATRIC THERAPY |
| NPI Number: | 1912242223 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRITTANY K VICKERS (BUSINESS OWNER) |
| Mailing Address: | 1106 2nd St W Williston |
| State: | ND US |
| Postal Code: | 588015804 |
| Phone Number: | 7015725974 |
| Fax Number: | 8662795137 |
| NPI Enumeration Date: | 11/28/2012 |
| NPI Last Update Date: | 11/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 1036 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| 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 |