Provider Demographics
NPI:1679362719
Name:WILSON, KAITLYN PATRICIA (SLPA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:PATRICIA
Last Name:WILSON
Suffix:
Gender:
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JEFFERSON PKWY APT 112
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8809
Mailing Address - Country:US
Mailing Address - Phone:503-750-6295
Mailing Address - Fax:
Practice Address - Street 1:1 JEFFERSON PKWY APT 112
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8809
Practice Address - Country:US
Practice Address - Phone:503-750-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95162355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant