Provider Demographics
NPI:1245471697
Name:WILMA, AMY J (MA-CCC/SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:WILMA
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 FRANCE AVE S STE 305
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4313
Mailing Address - Country:US
Mailing Address - Phone:952-285-2840
Mailing Address - Fax:952-285-2830
Practice Address - Street 1:7250 FRANCE AVE S STE 305
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4313
Practice Address - Country:US
Practice Address - Phone:952-285-2840
Practice Address - Fax:952-285-8230
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist