Individual
MR. KENNETH DWAYNE WILKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
1100 LIBRA DR, PORTALES, NM 88130-6124
(575) 693-8865
Mailing address
1100 LIBRA DR, PORTALES, NM 88130-6124
(575) 693-8865
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1040
NM
Other
Enumeration date
01/18/2007
Last updated
05/27/2009
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