Provider Demographics
NPI:1417916925
Name:WILSON, AMY CATHERINE (MA,CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CATHERINE
Last Name:WILSON
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 1:10535 BELLEAU DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1117
Mailing Address - Country:US
Mailing Address - Phone:216-288-9469
Mailing Address - Fax:
Practice Address - Street 1:33425 ARTHUR RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-4519
Practice Address - Country:US
Practice Address - Phone:440-349-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-8430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849916Medicaid
OH46-00039OtherUNITED HEALTHCARE INS. CO