Individual
GRETCHEN M WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5440 COPPER SPRINGS LN, CUMMING, GA 30040-5626
(704) 756-9324
Mailing address
5440 COPPER SPRINGS LN, CUMMING, GA 30040-5626
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3578
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7475056
—
NC
Enumeration date
12/15/2005
Last updated
08/13/2013
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