Provider Demographics
NPI:1164692661
Name:WILSON, ELYSE M (AUD)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:M
Other - Last Name:JAMEYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 356161
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6161
Mailing Address - Country:US
Mailing Address - Phone:206-598-2703
Mailing Address - Fax:206-598-6611
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356161
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6161
Practice Address - Country:US
Practice Address - Phone:206-598-2703
Practice Address - Fax:206-598-6611
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004746231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist