Individual
LISA JEAN WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2622 JASPER ST, PHILADELPHIA, PA 19125-1125
(206) 353-5708
Mailing address
2622 JASPER ST, PHILADELPHIA, PA 19125-1125
(206) 353-5708
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL014264
PA
Other
Enumeration date
11/08/2018
Last updated
11/08/2018
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