Provider Demographics
NPI:1588027064
Name:WILSON, VALERIE (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-7996
Mailing Address - Country:US
Mailing Address - Phone:425-985-6494
Mailing Address - Fax:
Practice Address - Street 1:145 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8144
Practice Address - Country:US
Practice Address - Phone:425-985-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60643266171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist