Provider Demographics
NPI:1659109650
Name:WILDFLOWER ABA
Entity type:Organization
Organization Name:WILDFLOWER ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-640-6438
Mailing Address - Street 1:49 JORDANS RD
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106-4033
Mailing Address - Country:US
Mailing Address - Phone:254-640-6438
Mailing Address - Fax:
Practice Address - Street 1:49 JORDANS RD
Practice Address - Street 2:
Practice Address - City:AMISSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20106-4033
Practice Address - Country:US
Practice Address - Phone:254-640-6438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty