Provider Demographics
NPI:1043966179
Name:WILSON, KIERA ILEEN ETTIE
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:ILEEN ETTIE
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 1:15600 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8449
Mailing Address - Country:US
Mailing Address - Phone:360-608-1753
Mailing Address - Fax:
Practice Address - Street 1:120 NE 136TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6951
Practice Address - Country:US
Practice Address - Phone:360-608-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst