Provider Demographics
NPI:1538727755
Name:WILSON, ALLISON NICOLE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:NICOLE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1201 WINTER GARDEN VINELAND RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4380
Mailing Address - Country:US
Mailing Address - Phone:850-890-4302
Mailing Address - Fax:
Practice Address - Street 1:1201 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4380
Practice Address - Country:US
Practice Address - Phone:407-654-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist