Individual
LISA MICHELE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
900 PACIFIC AVE, FIRST FLOOR, EVERETT, WA 98201-4168
(425) 258-7311
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 366-2983
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL60117765
WA
Other
Enumeration date
07/22/2011
Last updated
01/13/2016
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