| Doctor Name: | MRS. TANYSHA GIBBS WILSON |
| NPI Number: | 1720249287 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CCC-SLP L |
| License Number: | 09141511 |
| Business Practice Address: | 314 Hutchinson Ave Florence, SC - 29505 |
| Business Phone Number: | 8436640372 |
| Business Fax Number: | |
| Mailing Address: | 314 Hutchinson Ave, FLORENCE |
| State: | SC |
| Postal Code: | 29505 |
| Phone Number: | 8436640372 |
| Fax Number: | |
| NPI Enumeration Date: | 06/18/2008 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 09141511 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| 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 |