Doctor Name: | MRS. CAROL RUCH WYLIE |
NPI Number: | 1629231840 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | C.C.C./SLP |
License Number: | 146003535 |
Business Practice Address: | 901 Illini Dr East Peoria, IL - 616111840 |
Business Phone Number: | 3096946446 |
Business Fax Number: | 3096980650 |
Mailing Address: | 901 Illini Dr, EAST PEORIA |
State: | IL |
Postal Code: | 616111840 |
Phone Number: | 3096946446 |
Fax Number: | 3096980650 |
NPI Enumeration Date: | 07/08/2008 |
NPI Last Update Date: | 11/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146003535 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |