| Doctor Name: | BETHEL MCMULLEN WILSON |
| NPI Number: | 1174999411 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SA6035 |
| Business Practice Address: | 255 Se 7th Ave Suite 2 Crystal River, FL - 344294891 |
| Business Phone Number: | 3527954114 |
| Business Fax Number: | 3525632438 |
| Mailing Address: | 255 Se 7th Ave, Suite 2 CRYSTAL RIVER |
| State: | FL |
| Postal Code: | 344294891 |
| Phone Number: | 3527954114 |
| Fax Number: | 3525632438 |
| NPI Enumeration Date: | 08/20/2015 |
| NPI Last Update Date: | 08/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA6035 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| 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 |