Provider Demographics
NPI:1598033441
Name:WILSON, AMY LAUREN (MA, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LAUREN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S. SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-4942
Mailing Address - Country:US
Mailing Address - Phone:913-940-3181
Mailing Address - Fax:
Practice Address - Street 1:3100 BROADWAY
Practice Address - Street 2:SUITE 1000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2658
Practice Address - Country:US
Practice Address - Phone:816-756-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS08172225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist