Provider Demographics
NPI:1427574771
Name:WILTON, FLORENCE ANN (MA, CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:ANN
Last Name:WILTON
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1800
Mailing Address - Country:US
Mailing Address - Phone:618-466-0767
Mailing Address - Fax:
Practice Address - Street 1:1513 STATE ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3456
Practice Address - Country:US
Practice Address - Phone:618-463-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14600229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist