Provider Demographics
NPI:1942419072
Name:WILSON, STEPHANIE K (BS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:WILSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 EASTPOINT PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4164
Mailing Address - Country:US
Mailing Address - Phone:502-253-1293
Mailing Address - Fax:502-245-2034
Practice Address - Street 1:13101 EASTPOINT PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4164
Practice Address - Country:US
Practice Address - Phone:502-253-1293
Practice Address - Fax:502-245-2034
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist