Provider Demographics
NPI:1265865448
Name:WILCOX, BETH JULIE (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:JULIE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4547
Mailing Address - Country:US
Mailing Address - Phone:847-367-1086
Mailing Address - Fax:
Practice Address - Street 1:200 N FAIRWAY DR
Practice Address - Street 2:SUITE 208
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1861
Practice Address - Country:US
Practice Address - Phone:847-996-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist