Provider Demographics
NPI:1013149376
Name:WILKISON, LINDSAY JENNIFER (SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:JENNIFER
Last Name:WILKISON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:J
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:74 20TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9454
Mailing Address - Country:US
Mailing Address - Phone:360-389-8307
Mailing Address - Fax:
Practice Address - Street 1:74 20TH AVE CRT
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9454
Practice Address - Country:US
Practice Address - Phone:360-389-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60079604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist