Provider Demographics
NPI:1326255738
Name:WILBUR, SHOSHANNA BETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHOSHANNA
Middle Name:BETH
Last Name:WILBUR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:15100 SE 38TH ST # 751
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1728
Mailing Address - Country:US
Mailing Address - Phone:425-890-0998
Mailing Address - Fax:206-338-3560
Practice Address - Street 1:15100 SE 38TH ST # 751
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1728
Practice Address - Country:US
Practice Address - Phone:425-890-0998
Practice Address - Fax:206-338-3560
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALL00003501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist