| Doctor Name: | MS. MICHELLE WILSON |
| NPI Number: | 1245695253 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MM, MS, CF-SLP |
| License Number: | 01125L |
| Business Practice Address: | 4940 Eastern Ave Aa Building, Level 01 Baltimore, MD - 212242735 |
| Business Phone Number: | 4105500414 |
| Business Fax Number: | 4105501390 |
| Mailing Address: | 4940 Eastern Ave, Aa Building, Level 01 BALTIMORE |
| State: | MD |
| Postal Code: | 212242735 |
| Phone Number: | 4105500414 |
| Fax Number: | 4105501390 |
| NPI Enumeration Date: | 12/17/2015 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 01125L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| 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 |