MEDICARE: MRS. DEBORAH J WILSON 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
1	235Z00000X	Speech-Language Pathologist	22004267A	IN

General Provider Information

NPI Number	:	1013164094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH J WILSON SLP

Provider Business Mailing Address
First Line	:	5240 FERRARI DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-4503
Country	:	US
Telephone Number	:	719-357-1346
Fax Number	:

Provider Business Practice Location Address
First Line	:	5240 FERRARI DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-4503
Country	:	US
Telephone Number	:	719-357-1346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	12/26/2012

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