Provider Demographics
NPI:1164500294
Name:WILMOUTH, JOY PIRES (MS, CCC-SLP, CERTAVT)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:PIRES
Last Name:WILMOUTH
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CERTAVT
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:PIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP, AVT
Mailing Address - Street 1:P.O. BOX 6325
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-454-1937
Mailing Address - Fax:508-749-7058
Practice Address - Street 1:2 S SPOONER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4447
Practice Address - Country:US
Practice Address - Phone:508-454-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6037235500000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist