Healthcare Provider Details

I. General information

NPI: 1518286525
Provider Name (Legal Business Name): KRISTIN LEIGH WILSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 11/06/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5074 N HIGH ST
COLUMBUS OH
43214-1526
US

IV. Provider business mailing address

5074 N HIGH ST
COLUMBUS OH
43214-1526
US

V. Phone/Fax

Practice location:
  • Phone: 614-431-1010
  • Fax: 614-847-0015
Mailing address:
  • Phone: 614-431-1010
  • Fax: 614-847-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA.02124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: