Provider Demographics
NPI:1285611319
Name:BASKERVILLE, WILAINIA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WILAINIA
Middle Name:
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:WILAINIA
Other - Middle Name:
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 8266
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76307-8266
Mailing Address - Country:US
Mailing Address - Phone:940-696-6200
Mailing Address - Fax:940-696-6210
Practice Address - Street 1:1709 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5010
Practice Address - Country:US
Practice Address - Phone:940-696-6200
Practice Address - Fax:940-696-6210
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1050830OtherBLUE LINK #
TX8T4920OtherBCBS PROVIDER #
TX102098OtherHUMANA ID #