Individual
MRS. MICHAELYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.C/CCC-SLP
Contact information
Practice address
120 HANWORTH LN, DANIELS, WV 25832-9029
(304) 345-6313
(304) 763-7954
Mailing address
120 HANWORTH LN, DANIELS, WV 25832-9029
(304) 345-6313
(304) 763-7954
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1289
WV
235Z00000X
Speech-Language Pathologist
SP9302
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30610026
—
KY
Enumeration date
10/01/2007
Last updated
10/19/2010
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