Provider Demographics
NPI:1396975025
Name:WILSON, KRISTEN E (MS, BCBA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, BCBA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 NW 57TH LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4454
Mailing Address - Country:US
Mailing Address - Phone:954-243-6203
Mailing Address - Fax:
Practice Address - Street 1:1920 E ASPEN LEAF PL
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5512
Practice Address - Country:US
Practice Address - Phone:385-231-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9291235Z00000X
UT12347018-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist