Provider Demographics
NPI:1700681236
Name:WILKINSON, KELLY (MHC-P)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1612
Mailing Address - Country:US
Mailing Address - Phone:315-751-6254
Mailing Address - Fax:
Practice Address - Street 1:1129 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2845
Practice Address - Country:US
Practice Address - Phone:716-217-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P133720-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health