Individual
MRS. TANYSHA GIBBS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP L
Contact information
Practice address
314 HUTCHINSON AVE, FLORENCE, SC 29505
(843) 664-0372
Mailing address
314 HUTCHINSON AVE, FLORENCE, SC 29505
(843) 664-0372
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
09141511
MD
235Z00000X
Speech-Language Pathologist
Primary
2797
SC
Other
Enumeration date
06/18/2008
Last updated
06/18/2008
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