Provider Demographics
NPI:1447374608
Name:WILKSEN, THERESA KATHRYN (MA)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:KATHRYN
Last Name:WILKSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-2731
Mailing Address - Country:US
Mailing Address - Phone:209-599-2256
Mailing Address - Fax:
Practice Address - Street 1:3401 DALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0505
Practice Address - Country:US
Practice Address - Phone:209-527-7739
Practice Address - Fax:209-521-0776
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1884231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist