Provider Demographics
NPI:1184884520
Name:WILSON, KATHERINE JONES (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JONES
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 BLADES TRL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-9154
Mailing Address - Country:US
Mailing Address - Phone:843-621-7375
Mailing Address - Fax:
Practice Address - Street 1:8338 BLADES TRL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9154
Practice Address - Country:US
Practice Address - Phone:843-621-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4030235Z00000X
NC12168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist