Provider Demographics
NPI:1558134536
Name:WILSON, A'KAILA MONAE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:A'KAILA
Middle Name:MONAE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
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 292181
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0037
Mailing Address - Country:US
Mailing Address - Phone:843-812-9751
Mailing Address - Fax:
Practice Address - Street 1:390 FOX TROT DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7175
Practice Address - Country:US
Practice Address - Phone:843-812-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist