Provider Demographics
NPI:1336138056
Name:WILKINS, RONALD KENT JR (MS ED)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:KENT
Last Name:WILKINS
Suffix:JR
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 CODY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5214
Mailing Address - Country:US
Mailing Address - Phone:260-424-5576
Mailing Address - Fax:
Practice Address - Street 1:1712 CODY AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5214
Practice Address - Country:US
Practice Address - Phone:260-424-5576
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000103A101YM0800X
IN750482101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool