Individual
DR. KIMBERLY RENEE WILSON-LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD/CCC-SLP
Contact information
Practice address
462 BRECKENRIDGE TRCE, KINGSPORT, TN 37663-2988
(615) 669-6418
Mailing address
462 BRECKENRIDGE TRCE, KINGSPORT, TN 37663-2988
(615) 669-6418
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6628
TN
235Z00000X
Speech-Language Pathologist
SLP006884
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q048423
—
TN
Enumeration date
03/10/2015
Last updated
08/31/2020
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