Individual
JAMIE L. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA,CCC-SLP
Contact information
Practice address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
(336) 725-0454
Mailing address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
(336) 725-0454
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6390
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
144AV
BLUE CROSS BLUE SHIELD #
NC
05
—
7412651
—
NC
Enumeration date
12/12/2006
Last updated
09/27/2007
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