Provider Demographics
NPI:1154692705
Name:WILSON, ZILDA BREWER (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ZILDA
Middle Name:BREWER
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WOODBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9194
Mailing Address - Country:US
Mailing Address - Phone:859-223-2429
Mailing Address - Fax:
Practice Address - Street 1:53 WOODBRIAR CT
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9194
Practice Address - Country:US
Practice Address - Phone:859-223-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist