Healthcare Provider Details

I. General information

NPI: 1548174105
Provider Name (Legal Business Name): ASHLYN NICOLE WILSON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12006 98TH AVE NE STE 102
KIRKLAND WA
98034-4218
US

IV. Provider business mailing address

12006 98TH AVE NE STE 102
KIRKLAND WA
98034-4218
US

V. Phone/Fax

Practice location:
  • Phone: 425-576-1817
  • Fax:
Mailing address:
  • Phone: 425-576-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTA.MG.70157427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: