Provider Demographics
NPI:1811105356
Name:WILMOT, JEANNINE THERESE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:THERESE
Last Name:WILMOT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:THERESE
Other - Last Name:LAPLUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:10161 PARK RUN DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8872
Mailing Address - Country:US
Mailing Address - Phone:702-703-6408
Mailing Address - Fax:702-664-6761
Practice Address - Street 1:10161 PARK RUN DR STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8872
Practice Address - Country:US
Practice Address - Phone:702-703-6408
Practice Address - Fax:702-664-6761
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist