Doctor Name: | DIANE WILSON |
NPI Number: | 1447321872 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | |
Business Practice Address: | 353 Fairmont Blvd Rapid City, SD - 577017375 |
Business Phone Number: | 6057191409 |
Business Fax Number: | 6057197680 |
Mailing Address: | Po Box 3450, RAPID CITY |
State: | SD |
Postal Code: | 577093450 |
Phone Number: | 6057191409 |
Fax Number: | 6057197680 |
NPI Enumeration Date: | 11/09/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
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 |