Individual
ANNA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4300
Mailing address
PO BOX 2603, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76113-2603
(817) 569-4300
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
109931
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333583801
—
TX
01
—
8ES166
BCBS
TX
Enumeration date
05/01/2014
Last updated
08/29/2014
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