MEDICARE: DR. MICHELLE DAVIS WILSON SLP-CCC

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	10139	NC

General Provider Information

NPI Number	:	1649572371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE DAVIS WILSON SLP-CCC

Provider Business Mailing Address
First Line	:	11906 GREY PARTRIDGE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-0084
Country	:	US
Telephone Number	:	704-785-0162
Fax Number	:

Provider Business Practice Location Address
First Line	:	11906 GREY PARTRIDGE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-0084
Country	:	US
Telephone Number	:	704-785-0162
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	03/12/2026

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Directions to “ DR. MICHELLE DAVIS WILSON SLP-CCC” Practice Location

Language	Start Address	Practice Location

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