Individual
ELIZABETH CATHRYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
440 N BROAD ST, PHILADELPHIA, PA 19130-4015
(215) 317-2260
Mailing address
2423 ROSEMORE AVE, GLENSIDE, PA 19038-3513
(215) 317-2260
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL013626
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SL013626
—
PA
Enumeration date
10/31/2017
Last updated
10/31/2017
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