Provider Demographics
NPI:1336177047
Name:WILKINSON KEYLARD, LEAH MARIE (MA, CCC A)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:WILKINSON KEYLARD
Suffix:
Gender:F
Credentials:MA, CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S STE 313
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5772
Mailing Address - Country:US
Mailing Address - Phone:425-802-7399
Mailing Address - Fax:
Practice Address - Street 1:4033 TALBOT RD S STE 313
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-802-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002460231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0213493OtherLABOR AND INDUSTRIES
WA8316523Medicaid
WA8854069Medicare ID - Type Unspecified