MEDICARE: MRS. KATHRYN BROOKE YOUNG WILKERSON MS/CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202005533	VA

General Provider Information

NPI Number	:	1649416553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN BROOKE YOUNG WILKERSON MS/CCC-SLP

Provider Business Mailing Address
First Line	:	4227 TURBEVILLE RD
Second Line	:
City	:	ALTON
State	:	VA
Zip	:	24520-3349
Country	:	US
Telephone Number	:	434-579-0849
Fax Number	:

Provider Business Practice Location Address
First Line	:	5539 HIGHWAY FORTY SEVEN
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924-3727
Country	:	US
Telephone Number	:	434-372-8885
Fax Number	:	434-372-4162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2008
Last Update Date	:	06/28/2010

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