Provider Demographics
NPI:1841397569
Name:WILSON, GRACE CHRISTINE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:CHRISTINE
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 1:3706 N WILLIAMS
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2939
Mailing Address - Country:US
Mailing Address - Phone:405-946-6225
Mailing Address - Fax:
Practice Address - Street 1:3706 N WILLIAMS
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2939
Practice Address - Country:US
Practice Address - Phone:405-946-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2138235Z00000X
01025271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist