Provider Demographics
NPI:1518597574
Name:WILSON, JANET BEAM (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:BEAM
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9033
Mailing Address - Country:US
Mailing Address - Phone:919-762-7175
Mailing Address - Fax:984-225-2324
Practice Address - Street 1:721 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9033
Practice Address - Country:US
Practice Address - Phone:919-762-7175
Practice Address - Fax:984-225-2324
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist