Provider Demographics
NPI:1003186966
Name:WILSON, KYLE C (AUD)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:C
Last Name:WILSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2178
Mailing Address - Country:US
Mailing Address - Phone:315-363-5421
Mailing Address - Fax:
Practice Address - Street 1:221 BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2178
Practice Address - Country:US
Practice Address - Phone:315-363-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002386231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist