Provider Demographics
NPI:1245608074
Name:WILSON, PATRICK (MA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MA
Mailing Address - Zip Code:01254-1000
Mailing Address - Country:US
Mailing Address - Phone:203-885-2753
Mailing Address - Fax:
Practice Address - Street 1:250 CROSS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MA
Practice Address - Zip Code:01254-1000
Practice Address - Country:US
Practice Address - Phone:203-885-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist