Individual
ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
411 W HAYCRAFT AVE, SUITE D4, COEUR D ALENE, ID 83815-8105
(208) 664-2468
(208) 667-6239
Mailing address
411 W HAYCRAFT AVE, SUITE D4, COEUR D ALENE, ID 83815-8105
(208) 664-2468
(208) 667-6239
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
LL60026217
WA
235Z00000X
Speech-Language Pathologist
Primary
SLP-2219
ID
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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