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General NPI Number Information
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NPI Number | 1598784399
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Entity Type | Individual
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Provider Name | ELIZABETH JANE WILSON PHD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 1800 112TH AVE NE STE 240W
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City | BELLEVUE
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State | WA
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Zip | 98004-2965
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Country | US
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Telephone | 425-802-5232
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Fax | 425-484-9373
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Provider Business Mailing Address
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Address Line | 1800 112TH AVE NE STE 240W
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City | BELLEVUE
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State | WA
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Zip | 98004-2965
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Country | US
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Telephone | 425-802-5232
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Fax | 425-484-9373
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PYOOOO2288
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY00002288
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License Number State | WA
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