Healthcare Provider Details

I. General information

NPI: 1093628752
Provider Name (Legal Business Name): MADELINE WILKERSON M.S, CFY/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 TRIPLETT ST
OWENSBORO KY
42303-3564
US

IV. Provider business mailing address

815 TRIPLETT ST
OWENSBORO KY
42303-3564
US

V. Phone/Fax

Practice location:
  • Phone: 270-852-1439
  • Fax:
Mailing address:
  • Phone: 270-314-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number310757
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: