Provider Demographics
NPI:1013246123
Name:WILKERSON, IAN FRANKLIN (MT-BC, NMT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:FRANKLIN
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4769 PEREZOSO CALLE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2647
Mailing Address - Country:US
Mailing Address - Phone:707-480-7658
Mailing Address - Fax:
Practice Address - Street 1:4769 PEREZOSO CALLE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2647
Practice Address - Country:US
Practice Address - Phone:707-480-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist