Provider Demographics
NPI:1801161245
Name:WILKINS, BELLA (MA, SLP-CCC, TSSLD)
Entity type:Individual
Prefix:MS
First Name:BELLA
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MA, SLP-CCC, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 53RD ST
Mailing Address - Street 2:APT. 1603
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4667
Mailing Address - Country:US
Mailing Address - Phone:917-528-6236
Mailing Address - Fax:
Practice Address - Street 1:250 E 53RD ST
Practice Address - Street 2:APT. 1603
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4667
Practice Address - Country:US
Practice Address - Phone:917-528-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65700Medicaid