Provider Demographics
NPI:1295131100
Name:WILKINSON, VICTORIA (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:WILKINSON
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 1:9866 COUNTY ROAD 200
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-9339
Mailing Address - Country:US
Mailing Address - Phone:567-674-0258
Mailing Address - Fax:
Practice Address - Street 1:705 N IDA ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1060
Practice Address - Country:US
Practice Address - Phone:419-674-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist