Individual
DEANNE M WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
921 GIVENS RD, CHATTANOOGA, TN 37421-4315
(423) 505-6503
Mailing address
921 GIVENS RD, CHATTANOOGA, TN 37421-4315
(423) 505-6503
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
004249
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002142
TN SLP
TN
01
—
004249
GA SLP
GA
Enumeration date
01/30/2019
Last updated
01/30/2019
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