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Individual

KELLY LYNN WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 31905-2102
(706) 545-7308
Mailing address
6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 31905-2102
(706) 545-7308

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA13784
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
214307501
TX
01
80S945
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/14/2010
Last updated
12/13/2023
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