| Doctor Name: | MR. BRENT LEWIS WILES |
| NPI Number: | 1174985089 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., CCC-SLP |
| License Number: | SA12185 |
| Business Practice Address: | 18700 Us Highway 90 Robertsdale, AL - 365673271 |
| Business Phone Number: | 2519477729 |
| Business Fax Number: | 2519477235 |
| Mailing Address: | 18700 Us Highway 90, ROBERTSDALE |
| State: | AL |
| Postal Code: | 365673271 |
| Phone Number: | 2519477729 |
| Fax Number: | 2519477235 |
| NPI Enumeration Date: | 03/22/2016 |
| NPI Last Update Date: | 03/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA12185 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |