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NPI Code Detail

MEDICARE: MRS. WILAINIA BASKERVILLE M.S., CCC-SLP

MEDICARE: MRS. WILAINIA BASKERVILLE M.S., CCC-SLP
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 Pathologist102098TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11050830OTHERTXBLUE LINK #
28T4920OTHERTXBCBS PROVIDER #
3102098OTHERTXHUMANA ID #

General Provider Information

NPI Number : 1285611319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WILAINIA BASKERVILLE M.S., CCC-SLP
Provider Business Mailing Address
First Line : PO BOX 8266
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76307-8266
Country : US
Telephone Number : 940-696-6200
Fax Number : 940-696-6210
Provider Business Practice Location Address
First Line : 1709 10TH ST
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-5010
Country : US
Telephone Number : 940-696-6200
Fax Number : 940-696-6210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 08/07/2017

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Directions to “ MRS. WILAINIA BASKERVILLE M.S., CCC-SLP” Practice Location

Language Start Address Practice Location
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