Provider Demographics
NPI:1295976611
Name:WILK, AMY LOUISE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:WILK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-3413
Mailing Address - Country:US
Mailing Address - Phone:570-644-0216
Mailing Address - Fax:
Practice Address - Street 1:200 TAYLORSVILLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:PA
Practice Address - Zip Code:17964-9104
Practice Address - Country:US
Practice Address - Phone:570-644-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist