Provider Demographics
NPI:1942538970
Name:WIGHTMAN, ERIN N
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:N
Last Name:WIGHTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 23RD AVE NE APT A305
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8311
Mailing Address - Country:US
Mailing Address - Phone:206-947-1108
Mailing Address - Fax:
Practice Address - Street 1:725 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2051
Practice Address - Country:US
Practice Address - Phone:206-405-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 60122224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist