MEDICARE: AVA LORETTA WISHON

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	30003852	NC

General Provider Information

NPI Number	:	1720917768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA LORETTA WISHON

Provider Business Mailing Address
First Line	:	505 LAUCHWOOD DR
Second Line	:
City	:	LAURINBURG
State	:	NC
Zip	:	28352-5502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 LAUCHWOOD DR
Second Line	:
City	:	LAURINBURG
State	:	NC
Zip	:	28352-5502
Country	:	US
Telephone Number	:	910-501-4423
Fax Number	:

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

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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Directions to “ AVA LORETTA WISHON ” Practice Location

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