Individual
ELIZABETH MAE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
310 AUTUMN RIDGE DR, KOSCIUSKO, MS 39090-3242
(662) 289-7044
Mailing address
1221 HESTER RD, MATHISTON, MS 39752-6855
(662) 744-2825
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S-4954
MS
Other
Enumeration date
11/26/2024
Last updated
11/26/2024
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