Provider Demographics
NPI:1558663559
Name:WILKINSON, KATIE SIAS (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SIAS
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9900 SHELBYVILLE RD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2937
Mailing Address - Country:US
Mailing Address - Phone:502-915-8796
Mailing Address - Fax:502-805-0765
Practice Address - Street 1:9900 SHELBYVILLE RD STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2965
Practice Address - Country:US
Practice Address - Phone:502-915-8796
Practice Address - Fax:502-805-0765
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101584103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100332400Medicaid
KY101584OtherKENTUCKY APPLIED BEHAVIOR ANALYST LICENSING BOARD
1-06-2722OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD (BACB)