Provider Demographics
NPI:1255177044
Name:WILSON, CAITLIN MICHELLE (SLP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 NE 4418
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:OK
Mailing Address - Zip Code:74365-2472
Mailing Address - Country:US
Mailing Address - Phone:918-718-4558
Mailing Address - Fax:
Practice Address - Street 1:302 JOE KOELSCH DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:OK
Practice Address - Zip Code:74352
Practice Address - Country:US
Practice Address - Phone:918-479-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist