Provider Demographics
NPI:1902999089
Name:WILKINSON, SALLYE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLYE
Middle Name:M
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1887
Mailing Address - Country:US
Mailing Address - Phone:785-273-5238
Mailing Address - Fax:785-273-5906
Practice Address - Street 1:1508 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1887
Practice Address - Country:US
Practice Address - Phone:785-273-5238
Practice Address - Fax:785-273-5906
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS010880Medicare UPIN