Provider Demographics
NPI:1558085225
Name:WILSON, NATASHA (MA SLP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8979 GRAND PRIX LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2778
Mailing Address - Country:US
Mailing Address - Phone:561-703-0658
Mailing Address - Fax:
Practice Address - Street 1:8979 GRAND PRIX LN
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2778
Practice Address - Country:US
Practice Address - Phone:561-703-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist