Provider Demographics
NPI:1982837753
Name:WILSON, MAGGIE M (SLP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4033
Mailing Address - Country:US
Mailing Address - Phone:713-839-8255
Mailing Address - Fax:713-665-7563
Practice Address - Street 1:4830 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4033
Practice Address - Country:US
Practice Address - Phone:713-839-8255
Practice Address - Fax:713-665-7563
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist