Provider Demographics
NPI:1467232611
Name:WILKISON, HAZEL MARIE
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:MARIE
Last Name:WILKISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAZEL
Other - Middle Name:MARIE
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 SE ELY ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3747
Mailing Address - Country:US
Mailing Address - Phone:360-632-1255
Mailing Address - Fax:
Practice Address - Street 1:35 SE ELY ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3747
Practice Address - Country:US
Practice Address - Phone:360-632-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician