Organization
WILSON PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRESTA LEIGH WILSON M.S. CCC-SLP (OWNER/MANAGER)
(859) 475-4305
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
2251P0200X
Pediatric Physical Therapist
005311
KY
225XP0200X
Pediatric Occupational Therapist
R4342
KY
235Z00000X
Speech-Language Pathologist
Primary
KY 3201
KY
235Z00000X
Speech-Language Pathologist
KY 3472
KY
235Z00000X
Speech-Language Pathologist
KY 3597
KY
235Z00000X
Speech-Language Pathologist
KY 4155
KY
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100658910
—
KY
Enumeration date
04/05/2013
Last updated
07/21/2020
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