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General NPI Number Information
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NPI Number | 1285912204
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Entity Type | Individual
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Provider Name | KATHRYN RUTH WILSON M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 151 N SUNRISE AVE SUITE 1105
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City | ROSEVILLE
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State | CA
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Zip | 95661-2924
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Country | US
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Telephone | 916-771-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N SUNRISE AVE SUITE 1105
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City | ROSEVILLE
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State | CA
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Zip | 95661-2924
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Country | US
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Telephone | 916-771-8255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S3598
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 20735
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 06878
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP000582
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA12159
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License Number State | FL
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