Individual
JEANNIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1807 W MOLINE ST, MALVERN, AR 72104-2645
(501) 467-3166
Mailing address
25435 HIGHWAY 51, MALVERN, AR 72104-8972
(501) 844-4876
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP93
AR
Other
Enumeration date
11/11/2008
Last updated
11/11/2008
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