Provider Demographics
NPI:1598938102
Name:WILCOX, SUSAN J (MCD,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 UTNAGE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9377
Mailing Address - Country:US
Mailing Address - Phone:870-897-3724
Mailing Address - Fax:
Practice Address - Street 1:701 UTNAGE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9377
Practice Address - Country:US
Practice Address - Phone:870-897-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist