Individual
AMY WILKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
9781 CRANE DR, MYRTLE BEACH, SC 29572-5530
(843) 455-7505
Mailing address
9781 CRANE DR, MYRTLE BEACH, SC 29572-5530
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3188
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0628
—
SC
Enumeration date
06/21/2006
Last updated
07/08/2007
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