| Doctor Name: | MARY WILSON |
| NPI Number: | 1205205093 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCC-SLP |
| License Number: | 102066 |
| Business Practice Address: | 1126 W Pioneer Pkwy Suite 1126 Arlington, TX - 760136367 |
| Business Phone Number: | 8177951291 |
| Business Fax Number: | |
| Mailing Address: | 305 Ne Loop 820, Business Tower 1, Suite 200 HURST |
| State: | TX |
| Postal Code: | 760537209 |
| Phone Number: | 8172928787 |
| Fax Number: | 8177896849 |
| NPI Enumeration Date: | 09/22/2015 |
| NPI Last Update Date: | 09/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 102066 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| 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 |