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General NPI Number Information
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NPI Number | 1427574771
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Entity Type | Individual
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Provider Name | FLORENCE ANN WILTON M.A., CCC-SP
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Gender | Female
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 08/18/2017
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Provider Practice Location Address
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Address Line | 1513 STATE ST
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City | ALTON
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State | IL
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Zip | 62002-3456
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Country | US
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Telephone | 618-463-2134
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Fax |
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Provider Business Mailing Address
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Address Line | 907 HAMPTON CT
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City | GODFREY
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State | IL
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Zip | 62035-1800
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Country | US
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Telephone | 618-466-0767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14600229
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License Number State | IL
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