Provider Demographics
NPI:1376095539
Name:WILSON, AMINA C
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 CLAY AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5928
Mailing Address - Country:US
Mailing Address - Phone:917-273-7163
Mailing Address - Fax:
Practice Address - Street 1:2510 WESTCHESTER AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3585
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist