Provider Demographics
NPI:1083878318
Name:WILSON, LATRELLE ZORN (MSC CCC A)
Entity Type:Individual
Prefix:MRS
First Name:LATRELLE
Middle Name:ZORN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSC CCC A
Other - Prefix:MISS
Other - First Name:LATRELLE
Other - Middle Name:BEATRICE
Other - Last Name:ZORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSC CCC A
Mailing Address - Street 1:2163 NORMANDIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2750
Mailing Address - Country:US
Mailing Address - Phone:334-284-1870
Mailing Address - Fax:334-284-2112
Practice Address - Street 1:2163 NORMANDIE DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2750
Practice Address - Country:US
Practice Address - Phone:334-284-1870
Practice Address - Fax:334-284-2112
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ASHA01121390231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist