Provider Demographics
NPI:1801177662
Name:WILKINSON, CONSTANCE MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 HILLCREST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3551
Mailing Address - Country:US
Mailing Address - Phone:206-919-3953
Mailing Address - Fax:
Practice Address - Street 1:4046 HILLCREST AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3551
Practice Address - Country:US
Practice Address - Phone:206-919-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist