Provider Demographics
NPI:1356678379
Name:RALSTON-WILSON, JAIME A (DAOM, LAC, EAMP)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:RALSTON-WILSON
Suffix:
Gender:F
Credentials:DAOM, LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5371
Mailing Address - Street 2:SEATTLE CHILDREN'S, MS MB.11.500.3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5005
Mailing Address - Country:US
Mailing Address - Phone:206-987-1520
Mailing Address - Fax:206-987-3935
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-1520
Practice Address - Fax:206-987-3935
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60272459171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist