Provider Demographics
NPI:1043825243
Name:WILSON, CELIA BURGESS (SLPA)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:BURGESS
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 W BOYCE ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3004
Mailing Address - Country:US
Mailing Address - Phone:803-433-9001
Mailing Address - Fax:803-433-9002
Practice Address - Street 1:297 W BOYCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3004
Practice Address - Country:US
Practice Address - Phone:803-433-9001
Practice Address - Fax:803-433-9002
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC73582355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant