Provider Demographics
NPI:1780838094
Name:WILKINS, ALICE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 AVENUE OF THE AMERICAS
Mailing Address - Street 2:ROOM 225
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2019
Mailing Address - Country:US
Mailing Address - Phone:646-459-3936
Mailing Address - Fax:646-459-3404
Practice Address - Street 1:590 AVENUE OF THE AMERICAS
Practice Address - Street 2:ROOM 225
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2019
Practice Address - Country:US
Practice Address - Phone:646-459-3936
Practice Address - Fax:646-459-3404
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005403-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005403-1OtherNEW YORK STATE OFFICE OF THE PROFESSIONS STATE EDUCATION DEPARTMENT