Organization
WILSON PEDIATRIC THERAPY LLC
Active
Organization
WILSON PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRESTA LEIGH WILSON M.S. CCC-SLP (OWNER/SPEECH LANGUAGE PATHOLOGIST)
(859) 806-5717
Entity
Organization
Contact information
Practice address
424 LEWIS HARGETT CIR # B-100, LEXINGTON, KY 40503-3688
(859) 475-4305
(877) 804-4492
Mailing address
424 LEWIS HARGETT CIR # B-100, LEXINGTON, KY 40503-3688
(859) 475-4305
(877) 804-4492
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
3201
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100658910
—
KY
Enumeration date
02/26/2010
Last updated
09/24/2020
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