Provider Demographics
NPI:1780328070
Name:WILCOX, KRISTIN (MA SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50206-7753
Mailing Address - Country:US
Mailing Address - Phone:916-342-0157
Mailing Address - Fax:
Practice Address - Street 1:502 BUTLER ST
Practice Address - Street 2:
Practice Address - City:ACKLEY
Practice Address - State:IA
Practice Address - Zip Code:50601-1730
Practice Address - Country:US
Practice Address - Phone:641-847-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist