MEDICARE: YUTASHA WILKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	374U00000X	Home Health Aide
4	385H00000X	Respite Care

General Provider Information

NPI Number	:	1952076275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUTASHA WILKS

Provider Business Mailing Address
First Line	:	4209 N 25TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6615
Country	:	US
Telephone Number	:	262-894-6162
Fax Number	:

Provider Business Practice Location Address
First Line	:	5649 W WOOD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-6324
Country	:	US
Telephone Number	:	262-993-1444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	08/23/2023

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Directions to “ YUTASHA WILKS ” Practice Location

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