Provider Demographics
NPI:1225225469
Name:WILSON, MARTHA WILDER (AUD CCCA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:WILDER
Last Name:WILSON
Suffix:
Gender:F
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 HALEY CENTER
Mailing Address - Street 2:
Mailing Address - City:AUBURN UNIVERSITY
Mailing Address - State:AL
Mailing Address - Zip Code:36849-5232
Mailing Address - Country:US
Mailing Address - Phone:334-844-9600
Mailing Address - Fax:334-844-4585
Practice Address - Street 1:1199 HALEY CENTER
Practice Address - Street 2:
Practice Address - City:AUBURN UNIVERSITY
Practice Address - State:AL
Practice Address - Zip Code:36849-5232
Practice Address - Country:US
Practice Address - Phone:334-844-9600
Practice Address - Fax:334-844-4585
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL656A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist