Provider Demographics
NPI:1457306169
Name:WILSON, CINDY (CCC-A/FAAA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CCC-A/FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2766 W 11 MILE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3033
Mailing Address - Country:US
Mailing Address - Phone:248-544-0560
Mailing Address - Fax:248-544-7480
Practice Address - Street 1:2766 W 11 MILE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-3033
Practice Address - Country:US
Practice Address - Phone:248-544-0560
Practice Address - Fax:248-544-7480
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002743237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P15350Medicare ID - Type UnspecifiedPART B