Individual
CARLIE ANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 W RUNKE DR APT 5311, FLAGSTAFF, AZ 86001-6570
(928) 713-2595
Mailing address
2081 JUPITER LN, PRESCOTT, AZ 86301-4314
(928) 713-2595
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
14989
AZ
Other
Enumeration date
02/27/2024
Last updated
02/27/2024
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