Healthcare Provider Details

I. General information

NPI: 1427807254
Provider Name (Legal Business Name): JESSICA WILSON AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 SOUTHEAST BLVD # A
SALEM OH
44460-3418
US

IV. Provider business mailing address

3837 OLD FORGE RD
ROOTSTOWN OH
44272-9673
US

V. Phone/Fax

Practice location:
  • Phone: 440-372-0183
  • Fax: 330-337-7130
Mailing address:
  • Phone: 330-541-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA.02520
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: