Doctor Name: | MS. MARET ELIZABETH WILSON |
NPI Number: | 1437340833 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | RPE 4742 |
Business Practice Address: | 30 N San Pedro Rd Suite 265 San Rafael, CA - 949034118 |
Business Phone Number: | 4154797880 |
Business Fax Number: | 4154797889 |
Mailing Address: | 30 N San Pedro Rd, Suite 265 SAN RAFAEL |
State: | CA |
Postal Code: | 949034118 |
Phone Number: | 4154797880 |
Fax Number: | 4154797889 |
NPI Enumeration Date: | 08/09/2007 |
NPI Last Update Date: | 08/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | RPE 4742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
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 |