Healthcare Provider Details

I. General information

NPI: 1518804681
Provider Name (Legal Business Name): MIA WILKINSON SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 E BROWN RD
MESA AZ
85213-5430
US

IV. Provider business mailing address

7573 E 35TH ST
YUMA AZ
85365-8225
US

V. Phone/Fax

Practice location:
  • Phone: 602-875-5608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17238
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: