Provider Demographics
NPI:1205013802
Name:WILKENING, SONDRA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:WILKENING
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 OAKLAWN DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1109
Mailing Address - Country:US
Mailing Address - Phone:928-708-0108
Mailing Address - Fax:
Practice Address - Street 1:1678 OAKLAWN DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1109
Practice Address - Country:US
Practice Address - Phone:928-708-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ63121OtherAHCCCS