Provider Demographics
NPI:1013719392
Name:WILSON, EMILY T
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:T
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:TESSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7025 HALCYON PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7763
Mailing Address - Country:US
Mailing Address - Phone:334-372-8507
Mailing Address - Fax:
Practice Address - Street 1:7025 HALCYON PARK DR STE A
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7763
Practice Address - Country:US
Practice Address - Phone:334-372-8507
Practice Address - Fax:334-396-1684
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4169237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist