Provider Demographics
NPI:1760753842
Name:WILSON, MARJORIE ELAINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ELAINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS 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:PO BOX 724
Mailing Address - Street 2:99 SOUTH ROAD
Mailing Address - City:RYE BEACH
Mailing Address - State:NH
Mailing Address - Zip Code:03871-0724
Mailing Address - Country:US
Mailing Address - Phone:603-379-2974
Mailing Address - Fax:
Practice Address - Street 1:11 SANDY POINT RD
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2121
Practice Address - Country:US
Practice Address - Phone:603-778-8193
Practice Address - Fax:603-778-0388
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist