Provider Demographics
NPI:1033828975
Name:WILSON, HEATHER ANNE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 KIRBY AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3190
Mailing Address - Country:US
Mailing Address - Phone:540-836-9760
Mailing Address - Fax:
Practice Address - Street 1:1221 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3336
Practice Address - Country:US
Practice Address - Phone:540-949-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist