Healthcare Provider Details

I. General information

NPI: 1184806275
Provider Name (Legal Business Name): MS. RHEA C WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 THIMBLE SHOALS BLVD
NEWPORT NEWS VA
23606-4217
US

IV. Provider business mailing address

2778 TRACY PL
FORT EUSTIS VA
23604-1317
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-2932
  • Fax:
Mailing address:
  • Phone: 620-238-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: