Provider Demographics
NPI:1326595596
Name:WILKINS, SYDNIE
Entity Type:Individual
Prefix:
First Name:SYDNIE
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 MULBERRY HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:AR
Mailing Address - Zip Code:72947-8948
Mailing Address - Country:US
Mailing Address - Phone:479-430-8754
Mailing Address - Fax:
Practice Address - Street 1:2609 MULBERRY HIGHWAY 64 W
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:AR
Practice Address - Zip Code:72947-8948
Practice Address - Country:US
Practice Address - Phone:479-430-8754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-0166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16-0166OtherMEDICAID REGISTRATION NUMBER