Provider Demographics
NPI:1770849267
Name:WILKINS, AMBER RAE (MA, SLP, CCC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RAE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MA, SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2030
Mailing Address - Country:US
Mailing Address - Phone:708-539-4457
Mailing Address - Fax:
Practice Address - Street 1:11901 GOLDEN GATE DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2030
Practice Address - Country:US
Practice Address - Phone:708-539-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12149622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist