Provider Demographics
NPI:1083226617
Name:WILSON, ERYN NICOLE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:ERYN
Other - Middle Name:
Other - Last Name:RECTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2551
Mailing Address - Country:US
Mailing Address - Phone:870-736-0184
Mailing Address - Fax:
Practice Address - Street 1:912 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4033
Practice Address - Country:US
Practice Address - Phone:870-534-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist