Provider Demographics
NPI:1710412648
Name:WILSON, CHERI E (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:E
Other - Last Name:CULBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:254 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:TX
Mailing Address - Zip Code:75473-5519
Mailing Address - Country:US
Mailing Address - Phone:903-249-3734
Mailing Address - Fax:
Practice Address - Street 1:254 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:TX
Practice Address - Zip Code:75473-5519
Practice Address - Country:US
Practice Address - Phone:903-249-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist