Provider Demographics
NPI:1598166852
Name:WILSON, MEREDITH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 W GULLEY AVE # 954
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34760-8996
Mailing Address - Country:US
Mailing Address - Phone:407-968-8339
Mailing Address - Fax:
Practice Address - Street 1:390 W GULLEY AVE # 954
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34760-8996
Practice Address - Country:US
Practice Address - Phone:407-968-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist