Provider Demographics
NPI:1659022648
Name:WILSON, ROSEMARY (CCC)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEN FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-8817
Mailing Address - Country:US
Mailing Address - Phone:412-352-3679
Mailing Address - Fax:
Practice Address - Street 1:1500 ARDMORE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4468
Practice Address - Country:US
Practice Address - Phone:412-271-8347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006410L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist