Provider Demographics
NPI:1851127062
Name:WILBOURN, ASHLEY TAPPER
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TAPPER
Last Name:WILBOURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10612 LARIAT TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-3432
Mailing Address - Country:US
Mailing Address - Phone:901-292-9550
Mailing Address - Fax:
Practice Address - Street 1:450 LUKENBACH DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4390
Practice Address - Country:US
Practice Address - Phone:469-219-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist