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NPI Code Detail

MEDICARE: MICHELLE WILSON SLP

MEDICARE: MICHELLE 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
1235Z00000XSpeech-Language PathologistSP4994OH

General Provider Information

NPI Number : 1194957662
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE WILSON SLP
Provider Business Mailing Address
First Line : 1009 MAGNOLIA ST
Second Line :
City : SAINT MARYS
State : OH
Zip : 45885-1410
Country : US
Telephone Number : 419-394-1489
Fax Number :
Provider Business Practice Location Address
First Line : 476 FORTMAN DR
Second Line :
City : SAINT MARYS
State : OH
Zip : 45885-1870
Country : US
Telephone Number : 419-300-8400
Fax Number : 419-300-8401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2009
Last Update Date : 08/18/2009

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Directions to “ MICHELLE WILSON SLP” Practice Location

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