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NPI Code Detail

MEDICARE: JEANNINE THERESE WILMOT M.S. CCC-SLP

MEDICARE: JEANNINE THERESE WILMOT M.S. CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP-1000NV

General Provider Information

NPI Number : 1811105356
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNINE THERESE WILMOT M.S. CCC-SLP
Provider Business Mailing Address
First Line : 10161 PARK RUN DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-8872
Country : US
Telephone Number : 702-703-6408
Fax Number : 702-664-6761
Provider Business Practice Location Address
First Line : 10161 PARK RUN DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-8872
Country : US
Telephone Number : 702-703-6408
Fax Number : 702-664-6761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 04/10/2023

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Directions to “ JEANNINE THERESE WILMOT M.S. CCC-SLP” Practice Location

Language Start Address Practice Location
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