Provider Demographics
NPI:1962780189
Name:WILKERSON, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WILKERSON
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:PO BOX 8114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0114
Mailing Address - Country:US
Mailing Address - Phone:423-622-1551
Mailing Address - Fax:423-622-1556
Practice Address - Street 1:510 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3468
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:423-622-1556
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)