| Doctor Name: | ELIZABETH WILSON |
| NPI Number: | 1750629937 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., CCC-SLP |
| License Number: | LL60026217 |
| Business Practice Address: | 411 W Haycraft Ave Suite D4 Coeur D Alene, ID - 838158105 |
| Business Phone Number: | 2086642468 |
| Business Fax Number: | 2086676239 |
| Mailing Address: | 411 W Haycraft Ave, Suite D4 COEUR D ALENE |
| State: | ID |
| Postal Code: | 838158105 |
| Phone Number: | 2086642468 |
| Fax Number: | 2086676239 |
| NPI Enumeration Date: | 01/23/2013 |
| NPI Last Update Date: | 01/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | LL60026217 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |