Individual
BROOKE L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1143 SALT CREEK DRIVE, PONTE VEDRA BEACH, FL 32082
(321) 230-3800
Mailing address
1143 SALT CREEK DRIVE, PONTE VEDRA BEACH, FL 32082
(904) 318-6969
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA11587
FL
235Z00000X
Speech-Language Pathologist
SZ5331
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010224300
—
FL
Enumeration date
09/01/2011
Last updated
03/23/2018
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