Individual
MS. HEATHER ROSE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCCSLP
Contact information
Practice address
232 W 25TH ST, ERIE, PA 16544-0002
(814) 452-5119
Mailing address
2051 PLANK RD, CORRY, PA 16407-4601
(440) 465-9522
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL012682
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12093686
ASHA
—
01
—
SL012682
PA SLP LICENSE
PA
Enumeration date
09/28/2006
Last updated
01/19/2017
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