Provider Demographics
NPI:1417721952
Name:WILKERSON, ARIEAL
Entity Type:Individual
Prefix:MRS
First Name:ARIEAL
Middle Name:
Last Name:WILKERSON
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:PURDIN
Mailing Address - State:MO
Mailing Address - Zip Code:64674-0130
Mailing Address - Country:US
Mailing Address - Phone:660-244-5045
Mailing Address - Fax:
Practice Address - Street 1:15533 HIGHWAY KK
Practice Address - Street 2:
Practice Address - City:PURDIN
Practice Address - State:MO
Practice Address - Zip Code:64674-8231
Practice Address - Country:US
Practice Address - Phone:660-244-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190114272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant