John Matthew Wilson, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL00002640 Issued in WA

Practice address

3517 Norfolk CT SE
Olympia, WA 98501-7021

Phone

(360) 705-1107

Fax

(360) 357-5900

NPI assigned

Sep 18, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• John Wilson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1265782213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3517 NORFOLK CT SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985017021",
            "telephone_number": "360-705-1107",
            "fax_number": "360-357-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3517 NORFOLK CT SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985017021",
            "telephone_number": "360-705-1107",
            "fax_number": "360-357-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JOHN",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-18",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00002640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "WILSON",
            "credential": "CCC-SLP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Deirdre Lynne Wilson, ED.D.
• Edith Diane Wilson, MD
• Emily Anne Wilson, LMT
• Emma Wilson
• Jeffrey Todd Wilson
• Kerri Lynn Wilson
• Miyah A Wilson
• Nathan R Wilson, CAAR
• Sara Wilson, PT
• Stephen Tierri Wilson, MSW, ACSW, LICSW

• Speech-Language Pathologist in Olympia, WA
• Providers in Olympia, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.