Individual
BRIGETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 EUCLID AVE # IM269, CLEVELAND, OH 44115-2214
(216) 687-3806
Mailing address
2121 EUCLID AVE, CLEVELAND, OH 44115-2214
(216) 687-3806
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP5583
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0408286
—
OH
01
—
366525
MEDICARE PTAN
OH
Enumeration date
11/18/2014
Last updated
02/11/2022
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