Provider Demographics
NPI:1700493509
Name:IRWIN, JOHN WILSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILSON
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9408
Mailing Address - Country:US
Mailing Address - Phone:919-951-5465
Mailing Address - Fax:
Practice Address - Street 1:19 SAINT JAMES CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9408
Practice Address - Country:US
Practice Address - Phone:919-951-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty