Provider Demographics
NPI:1629626866
Name:WILKINSON, DAVIA
Entity Type:Individual
Prefix:
First Name:DAVIA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MARCELLA RD APT 806
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2596
Mailing Address - Country:US
Mailing Address - Phone:757-951-3167
Mailing Address - Fax:
Practice Address - Street 1:302 DARE RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2716
Practice Address - Country:US
Practice Address - Phone:757-898-0300
Practice Address - Fax:855-878-9063
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist