Provider Demographics
NPI:1427422153
Name:WILSON, KASSONDRA LYNN
Entity type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-9006
Mailing Address - Country:US
Mailing Address - Phone:206-892-8325
Mailing Address - Fax:844-848-7543
Practice Address - Street 1:201 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-9006
Practice Address - Country:US
Practice Address - Phone:206-892-8325
Practice Address - Fax:844-848-7543
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health