Provider Demographics
NPI:1982802500
Name:WILSON, KERRY JASKUNAS (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:JASKUNAS
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 TRENHOLM DR
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1329
Mailing Address - Country:US
Mailing Address - Phone:703-865-4879
Mailing Address - Fax:
Practice Address - Street 1:3137 TRENHOLM DR
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1329
Practice Address - Country:US
Practice Address - Phone:703-865-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist