Individual
KAITLYN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2025 WHITE OAKS BLVD, BRIDGEPORT, WV 26330-5402
(304) 612-9592
Mailing address
25 LOFTY LN, MONTANA MINES, WV 26586-2700
(304) 612-9592
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-0986
WV
Other
Enumeration date
08/04/2023
Last updated
08/04/2023
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