Provider Demographics
NPI:1225516123
Name:WILSON, JIREE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JIREE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BENNET
Mailing Address - State:NE
Mailing Address - Zip Code:68317-2420
Mailing Address - Country:US
Mailing Address - Phone:402-560-1421
Mailing Address - Fax:
Practice Address - Street 1:50 DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:BENNET
Practice Address - State:NE
Practice Address - Zip Code:68317-2029
Practice Address - Country:US
Practice Address - Phone:402-782-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14032803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist