Provider Demographics
NPI:1063281590
Name:WILFONG, KADASHIA (BSW)
Entity type:Individual
Prefix:
First Name:KADASHIA
Middle Name:
Last Name:WILFONG
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 WESTMEAD DR APT 4015
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4726
Mailing Address - Country:US
Mailing Address - Phone:713-504-8451
Mailing Address - Fax:
Practice Address - Street 1:3663 N SAM HOUSTON PKWY E STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3611
Practice Address - Country:US
Practice Address - Phone:713-504-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management