Provider Demographics
NPI:1457845430
Name:WILCOX, DALANA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DALANA
Middle Name:MARIE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DALANA
Other - Middle Name:MARIE
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-6405
Mailing Address - Country:US
Mailing Address - Phone:859-462-1287
Mailing Address - Fax:
Practice Address - Street 1:529 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2949
Practice Address - Country:US
Practice Address - Phone:270-763-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty