Provider Demographics
NPI:1780978791
Name:WILTON, WENDY MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARIE
Last Name:WILTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:MARIE
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1206 COUNTY RD 1000 N
Mailing Address - Street 2:
Mailing Address - City:DAHLGREN
Mailing Address - State:IL
Mailing Address - Zip Code:62828
Mailing Address - Country:US
Mailing Address - Phone:618-731-0834
Mailing Address - Fax:
Practice Address - Street 1:1201 HAWTHRON RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881
Practice Address - Country:US
Practice Address - Phone:618-548-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001712235Z00000X
IL146.010.891235Z00000X
IL146010391235Z00000X
IL146.010891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist