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NPI Code Detail

MEDICARE: KRISTEN WILKEN ST

MEDICARE: KRISTEN WILKEN ST
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 Pathologist

General Provider Information

NPI Number : 1871674747
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN WILKEN ST
Provider Business Mailing Address
First Line : 1606 HUNT DR
Second Line :
City : NORMAL
State : IL
Zip : 61761-2192
Country : US
Telephone Number : 309-452-0069
Fax Number : 309-451-8989
Provider Business Practice Location Address
First Line : 1606 HUNT DR
Second Line :
City : NORMAL
State : IL
Zip : 61761-2192
Country : US
Telephone Number : 309-452-0069
Fax Number : 309-451-8989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 07/08/2007

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Directions to “ KRISTEN WILKEN ST” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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