Individual
LISA WEAR WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD, CCC-A
Contact information
Practice address
4502 MEDICAL DR, HEARING AND BALANCE CENTER, SAN ANTONIO, TX 78229-4402
(210) 358-4583
(210) 358-2654
Mailing address
4502 MEDICAL DR, HEARING AND BALANCE CENTER, SAN ANTONIO, TX 78229-4402
(210) 358-4583
(210) 358-2654
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
80134
TX
231H00000X
Audiologist
Primary
A 01362
OH
237600000X
Audiologist-Hearing Aid Fitter
80134
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04709
PARAMOUNT
OH
01
—
296609964-001
MMOH
OH
01
—
296609964-002
MMOH
OH
05
—
5187350
—
MI
01
—
P00434163
RRMC
OH
01
—
PENDING
AETNA
OH
Enumeration date
01/15/2007
Last updated
08/11/2009
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