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NPI Code Detail

MEDICARE: JACKLYN NICOLE WILSON

MEDICARE: JACKLYN NICOLE WILSON
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
1235Z00000XSpeech-Language PathologistSLPA10432AZ
2103K00000XBehavior Analyst1-23-65006DE
3106S00000XBehavior TechnicianRBT-20-143138DE

General Provider Information

NPI Number : 1861939548
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKLYN NICOLE WILSON
Provider Business Mailing Address
First Line : 5231 ANDREWVILLE RD
Second Line :
City : GREENWOOD
State : DE
Zip : 19950-2159
Country : US
Telephone Number : 302-381-0058
Fax Number :
Provider Business Practice Location Address
First Line : 5231 ANDREWVILLE RD
Second Line :
City : GREENWOOD
State : DE
Zip : 19950-2159
Country : US
Telephone Number : 302-381-0058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2017
Last Update Date : 11/14/2025

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Directions to “ JACKLYN NICOLE WILSON ” Practice Location

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