Provider Demographics
NPI:1609909159
Name:WILSON, KATHLEEN CLAIRE (MS,CCCSLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CLAIRE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS,CCCSLP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:EARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCCSLP
Mailing Address - Street 1:2025 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-6587
Mailing Address - Country:US
Mailing Address - Phone:731-707-8817
Mailing Address - Fax:
Practice Address - Street 1:2025 HILL ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-6587
Practice Address - Country:US
Practice Address - Phone:731-707-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist