Provider Demographics
NPI:1417111329
Name:WILSON, JON MICHAEL (MA CCC-A)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:MICHAEL
Last Name:WILSON
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2602
Mailing Address - Country:US
Mailing Address - Phone:970-266-8380
Mailing Address - Fax:970-266-8495
Practice Address - Street 1:195 TELLURIDE ST UNIT 3
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4358
Practice Address - Country:US
Practice Address - Phone:303-857-6688
Practice Address - Fax:303-857-6689
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO407237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter