Provider Demographics
NPI:1073631685
Name:WILCOX, DENA K (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:K
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 EDENDERRY WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7530
Mailing Address - Country:US
Mailing Address - Phone:843-496-9027
Mailing Address - Fax:
Practice Address - Street 1:181 E EVANS ST
Practice Address - Street 2:SUITE 310
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2511
Practice Address - Country:US
Practice Address - Phone:843-407-4189
Practice Address - Fax:843-407-4191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2884235Z00000X
VA2202001887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist