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Individual
KELLY LYNN WILSON
Active
Individual
KELLY LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA13784
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214307501
—
TX
01
—
80S945
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/14/2010
Last updated
08/26/2026
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