Individual
CARLY R WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2614 S 15TH PL, BROKEN ARROW, OK 74012-7286
(972) 741-4393
Mailing address
2614 S 15TH PL, BROKEN ARROW, OK 74012-7286
(972) 741-4393
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4136
OK
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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