Provider Demographics
NPI:1740749100
Name:WILKS, JULIE CRAFT (MA CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CRAFT
Last Name:WILKS
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N245 CUMNOR AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4753
Mailing Address - Country:US
Mailing Address - Phone:630-917-0468
Mailing Address - Fax:
Practice Address - Street 1:4S241 RIVER RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3815
Practice Address - Country:US
Practice Address - Phone:630-393-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist