Provider Demographics
NPI:1144648254
Name:WILCOXEN, JONATHAN (MT-BC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WILCOXEN
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 BURNET RD APT 915
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7060
Mailing Address - Country:US
Mailing Address - Phone:309-338-2370
Mailing Address - Fax:
Practice Address - Street 1:8524 BURNET RD APT 915
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7060
Practice Address - Country:US
Practice Address - Phone:309-338-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10844225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist