Basic Information
| Provider Information | |||||||||
| NPI: | 1992030654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | SUNSHINE | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2755 G ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921023114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194525064 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1570 E 17TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927058502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148341111 | ||||||||
| FaxNumber: | 7149720454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2009 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SI 60110325 | WA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP 20726 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.