| Doctor Name: | MS. JAYE STANSBURY WILSON |
| NPI Number: | 1689785388 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., CCC |
| License Number: | 1112 |
| Business Practice Address: | 535 E Pine St Riverside Professional Offices, Suite 211 Mount Airy, NC - 270303951 |
| Business Phone Number: | 3367861210 |
| Business Fax Number: | 3367861408 |
| Mailing Address: | Po Box 901, PILOT MOUNTAIN |
| State: | NC |
| Postal Code: | 270410901 |
| Phone Number: | 3367861210 |
| Fax Number: | 3367861408 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 1112 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| 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 |