Individual
JENNIFER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
808 MILL LAKE RD, FORT WAYNE, IN 46845-6400
(260) 338-1241
(260) 338-1231
Mailing address
808 MILL LAKE RD, FORT WAYNE, IN 46845-6400
(260) 338-1241
(260) 338-1231
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
220060930
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200860930
FIRST STEPS
IN
Enumeration date
04/29/2008
Last updated
04/29/2008
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