Provider Demographics
NPI:1275239469
Name:WILSON, KYESHA ALMONIQUE (BCBA)
Entity Type:Individual
Prefix:
First Name:KYESHA
Middle Name:ALMONIQUE
Last Name:WILSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 HUNTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-1315
Mailing Address - Country:US
Mailing Address - Phone:314-591-6113
Mailing Address - Fax:
Practice Address - Street 1:6325 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3209
Practice Address - Country:US
Practice Address - Phone:314-943-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst