Doctor Name: | MRS. BETHANY JAGODITSCH WILKS |
NPI Number: | 1447418801 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | 2007028032 |
Business Practice Address: | 6768 N Highway 67 Florissant, MO - 630342742 |
Business Phone Number: | 3147419101 |
Business Fax Number: | 3147414936 |
Mailing Address: | 6768 N Highway 67, FLORISSANT |
State: | MO |
Postal Code: | 630342742 |
Phone Number: | 3147419101 |
Fax Number: | 3147414936 |
NPI Enumeration Date: | 06/01/2008 |
NPI Last Update Date: | 06/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2007028032 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |