Healthcare Provider Details

I. General information

NPI: 1528587888
Provider Name (Legal Business Name): BRITTANY WILSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY CHISM

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 DOGWOOD DR
MILTON FL
32570-5708
US

IV. Provider business mailing address

7196 PUTTER LN
MILTON FL
32570-7972
US

V. Phone/Fax

Practice location:
  • Phone: 850-686-5671
  • Fax: 850-750-5686
Mailing address:
  • Phone: 850-686-5671
  • Fax: 850-750-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA20848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: