Individual
BETH R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
S.L.P
Contact information
Practice address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4395
(817) 569-4517
Mailing address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4395
(817) 569-4517
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
100554
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157410501
—
TX
01
—
8T1181
BCBS
TX
Enumeration date
12/18/2006
Last updated
05/21/2010
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