Provider Demographics
NPI:1407489834
Name:WILLSON, BECKY LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:WILLSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:L
Other - Last Name:WILLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1035 DAIRY ASHFORD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4691
Mailing Address - Country:US
Mailing Address - Phone:281-293-8004
Mailing Address - Fax:
Practice Address - Street 1:1035 DAIRY ASHFORD RD STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4691
Practice Address - Country:US
Practice Address - Phone:281-293-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist