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1316090053
KENNETH DWAYNE WILKERSON
PORTALES, NM
NPI
1316090053
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
235Z00000X Speech-Language Pathologist,
(Licence: NM 1040)
Enumeration Date
2007-01-18
Last Update Date
2009-05-27
Business Address
Mr. KENNETH DWAYNE WILKERSON M.S., CCC-SLP
1100 LIBRA DR
PORTALES, NM 88130-6124
Phone number: 575-693-8865
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Mailing Address
Mr. KENNETH DWAYNE WILKERSON M.S., CCC-SLP
1100 LIBRA DR
PORTALES, NM 88130-6124
Phone number: 575-693-8865
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