Provider Demographics
NPI:1821508607
Name:WILSON, KELLI J (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:JEAN
Other - Last Name:LINGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1310 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1501
Mailing Address - Country:US
Mailing Address - Phone:605-328-8200
Mailing Address - Fax:
Practice Address - Street 1:SANFORD EAR, NOSE & THROAT CLINIC TALLEY BUILDING
Practice Address - Street 2:1310 W. 22ND ST.
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-328-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist