| Doctor Name: | MS. MISTY WILSON |
| NPI Number: | 1407931421 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 15855 |
| Business Practice Address: | 515 W Lingleville Rd Stephenville, TX - 764012211 |
| Business Phone Number: | 2549653611 |
| Business Fax Number: | 2549653618 |
| Mailing Address: | 205 Ne 6th Ave, MINERAL WELLS |
| State: | TX |
| Postal Code: | 760674527 |
| Phone Number: | 9405210902 |
| Fax Number: | 2549653618 |
| NPI Enumeration Date: | 10/26/2006 |
| NPI Last Update Date: | 05/26/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 15855 |
| 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 |