Provider Demographics
NPI:1598003626
Name:WILKINSON, KELLI (SLP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6172 AIRWAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2984
Mailing Address - Country:US
Mailing Address - Phone:423-622-1551
Mailing Address - Fax:877-856-7133
Practice Address - Street 1:6172 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2984
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:877-856-7133
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist