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General NPI Number Information
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NPI Number | 1821508607
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Entity Type | Individual
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Provider Name | KELLI J WILSON AUD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | SANFORD EAR, NOSE & THROAT CLINIC TALLEY BUILDING 1310 W. 22ND ST.
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City | SIOUX FALLS
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State | SD
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Zip | 57105
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Country | US
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Telephone | 605-328-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 W 22ND ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1501
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Country | US
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Telephone | 605-328-8200
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 11710
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State | SD
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