Provider Demographics
NPI:1386992626
Name:WILSON, JOHN WILLIAM (HIS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:WILSON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12114 HANNIBAL ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80603-6959
Mailing Address - Country:US
Mailing Address - Phone:303-906-8886
Mailing Address - Fax:
Practice Address - Street 1:606 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601
Practice Address - Country:US
Practice Address - Phone:303-659-8760
Practice Address - Fax:303-659-8760
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO210237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist