Individual
AMANDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4031 SAN FERNANDO LN, SAINT CHARLES, MO 63304-2831
(636) 584-2302
Mailing address
4031 SAN FERNANDO LN, SAINT CHARLES, MO 63304-2831
(636) 584-2302
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2016009976
MO
Other
Enumeration date
05/03/2016
Last updated
03/10/2017
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