Individual
AMY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2120 WEST WASHINGTON STREET, SPRINGFIELD, IL 62702
(217) 793-4880
Mailing address
2120 W WASHINGTON ST, SPRINGFIELD, IL 62702-4630
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.011506
IL
Other
Enumeration date
07/26/2013
Last updated
07/26/2013
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