Provider Demographics
NPI:1598784399
Name:WILSON, ELIZABETH JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 112TH AVE NE STE 240W
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2965
Mailing Address - Country:US
Mailing Address - Phone:425-802-5232
Mailing Address - Fax:425-484-9373
Practice Address - Street 1:1800 112TH AVE NE STE 240W
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2965
Practice Address - Country:US
Practice Address - Phone:425-802-5232
Practice Address - Fax:425-484-9373
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPYOOOO2288103TC1900X
WAPY00002288103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling