Provider Demographics
NPI:1790722726
Name:WILKENS, SARA ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:WILKENS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 HAMILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5152
Mailing Address - Country:US
Mailing Address - Phone:423-267-6738
Mailing Address - Fax:423-209-9119
Practice Address - Street 1:1724 HAMILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5152
Practice Address - Country:US
Practice Address - Phone:423-267-6738
Practice Address - Fax:423-209-9119
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003700231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA205028716AMedicaid
GA205028716BMedicaid
GAQ39980Medicare UPIN
GA64BCBNKMedicare ID - Type Unspecified