Individual
MRS. REBECCA JEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 359-9570
Mailing address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 359-9570
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1914
ID
Other
Enumeration date
09/29/2009
Last updated
09/29/2009
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