Provider Demographics
NPI:1467614552
Name:WILSON, ALLYSON REGINA (SLP)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:REGINA
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 ALPHA RD STE 1150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4335
Mailing Address - Country:US
Mailing Address - Phone:214-796-3242
Mailing Address - Fax:
Practice Address - Street 1:4100 ALPHA RD STE 1150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4335
Practice Address - Country:US
Practice Address - Phone:214-796-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist