Provider Demographics
NPI:1376250688
Name:WILSON, TRAVIS STUART
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:STUART
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST STE 610
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2260
Mailing Address - Country:US
Mailing Address - Phone:509-448-1202
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST STE 610
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2260
Practice Address - Country:US
Practice Address - Phone:509-448-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator