Provider Demographics
NPI:1043947252
Name:VENTO-WILSON, MARGARET (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:
Last Name:VENTO-WILSON
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 PINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-243-2334
Mailing Address - Fax:
Practice Address - Street 1:3711 LONG BEACH BLVD
Practice Address - Street 2:SUITE 5046
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-9080
Practice Address - Country:US
Practice Address - Phone:562-243-2334
Practice Address - Fax:562-988-0888
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty