| Doctor Name: | SUSAN WILSON |
| NPI Number: | 1790938074 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 005268 |
| Business Practice Address: | 123 Dorchester Rd Scarsdale, NY - 105836052 |
| Business Phone Number: | 9144729081 |
| Business Fax Number: | |
| Mailing Address: | 123 Dorchester Rd, SCARSDALE |
| State: | NY |
| Postal Code: | 105836052 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/30/2008 |
| NPI Last Update Date: | 10/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 005268 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| 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 |