Individual
MRS. BRANDY L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
836 S BISHOP ST, GARDEN APT, CHICAGO, IL 60607-4022
(814) 598-9729
Mailing address
836 S BISHOP ST, GARDEN APT, CHICAGO, IL 60607-4022
(814) 598-9729
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146009590
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BRANDY0936
—
IL
Enumeration date
03/01/2010
Last updated
03/01/2010
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