Provider Demographics
NPI:1114259850
Name:WILLSON, MARIBEL (MSCCC SLP,TSSLD,BE)
Entity Type:Individual
Prefix:MRS
First Name:MARIBEL
Middle Name:
Last Name:WILLSON
Suffix:
Gender:F
Credentials:MSCCC SLP,TSSLD,BE
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:ARRIAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 PARK AV
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108
Mailing Address - Country:US
Mailing Address - Phone:856-425-2238
Mailing Address - Fax:856-210-7488
Practice Address - Street 1:1118 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-3317
Practice Address - Country:US
Practice Address - Phone:856-425-2238
Practice Address - Fax:856-210-7488
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00849400235Z00000X
KS3760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty