Provider Demographics
NPI:1851024079
Name:WILSON SPEECH, LANGAUGE, AND CONSULTING LLC
Entity Type:Organization
Organization Name:WILSON SPEECH, LANGAUGE, AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-869-6161
Mailing Address - Street 1:852 OLD COUNTRY RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6889
Mailing Address - Country:US
Mailing Address - Phone:919-869-6161
Mailing Address - Fax:
Practice Address - Street 1:852 OLD COUNTRY RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6889
Practice Address - Country:US
Practice Address - Phone:919-869-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech