| Doctor Name: | BROOKE L WILSON |
| NPI Number: | 1255612446 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCC-SLP |
| License Number: | SZ5331 |
| Business Practice Address: | 807 Childrens Way Nemours Childrens Clinic, Jacksonville Jacksonville, FL - 322078426 |
| Business Phone Number: | 9046973600 |
| Business Fax Number: | 9046973792 |
| Mailing Address: | Po Box 191, Provider Enrollment Department ROCKLAND |
| State: | DE |
| Postal Code: | 197320191 |
| Phone Number: | 4076507129 |
| Fax Number: | 3026514945 |
| NPI Enumeration Date: | 09/01/2011 |
| NPI Last Update Date: | 03/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SZ5331 |
| 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 |