Provider Demographics
NPI:1962605733
Name:WILSON, SUMALEE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUMALEE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 AUHUHU ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1143
Mailing Address - Country:US
Mailing Address - Phone:808-454-0506
Mailing Address - Fax:
Practice Address - Street 1:84-1061 NOHOLIO RD
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2247
Practice Address - Country:US
Practice Address - Phone:808-696-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist