Provider Demographics
NPI:1629406087
Name:WILSON, EMILY (MS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33330 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6325
Mailing Address - Country:US
Mailing Address - Phone:253-945-2086
Mailing Address - Fax:253-945-2177
Practice Address - Street 1:5830 S 300TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2311
Practice Address - Country:US
Practice Address - Phone:253-945-3212
Practice Address - Fax:253-945-2177
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60404789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist