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General NPI Number Information
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NPI Number | 1467543983
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Entity Type | Individual
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Provider Name | HEATHER ROSE WILSON MA CCCSLP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 232 W 25TH ST
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City | ERIE
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State | PA
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Zip | 16544-0002
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Country | US
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Telephone | 814-452-5119
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Fax |
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Provider Business Mailing Address
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Address Line | 2051 PLANK RD
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City | CORRY
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State | PA
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Zip | 16407-4601
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Country | US
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Telephone | 440-465-9522
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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 | SL012682
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License Number State | PA
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