Provider Demographics
NPI:1992043566
Name:WILSON, ELLEN MCGUIGAN (SLP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MCGUIGAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13219 NE PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9832
Mailing Address - Country:US
Mailing Address - Phone:360-342-4017
Mailing Address - Fax:
Practice Address - Street 1:13219 NE PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-9832
Practice Address - Country:US
Practice Address - Phone:760-868-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist