Provider Demographics
NPI:1487013942
Name:WILSON, ERIC CARL (HIS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CARL
Last Name:WILSON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2908
Mailing Address - Country:US
Mailing Address - Phone:216-321-1109
Mailing Address - Fax:216-321-1149
Practice Address - Street 1:4520 CATLIN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2535
Practice Address - Country:US
Practice Address - Phone:216-394-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02904237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist