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General NPI Number Information
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NPI Number | 1417111329
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Entity Type | Individual
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Provider Name | JON MICHAEL WILSON M.A. CCC-A
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Gender | Male
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 195 TELLURIDE ST UNIT 3
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City | BRIGHTON
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State | CO
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Zip | 80601-4358
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Country | US
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Telephone | 303-857-6688
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Fax | 303-857-6689
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Provider Business Mailing Address
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Address Line | 3100 REMINGTON ST
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City | FORT COLLINS
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State | CO
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Zip | 80525-2602
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Country | US
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Telephone | 970-266-8380
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Fax | 970-266-8495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 407
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 407
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License Number State | CO
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