Provider Demographics
NPI:1548997919
Name:WILSON, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
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 1:5000 NW VILLAGE PARK DR APT G
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-7875
Mailing Address - Country:US
Mailing Address - Phone:425-999-0085
Mailing Address - Fax:
Practice Address - Street 1:5000 NORTHWEST VILLAGE PARK DRIVE, APT G
Practice Address - Street 2:APT G241
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-9802
Practice Address - Country:US
Practice Address - Phone:425-999-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist