Provider Demographics
NPI:1598931370
Name:WILSON, ELLEN ROSSER (AUD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ROSSER
Last Name:WILSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 K M WICKER MEMORIAL DR
Mailing Address - Street 2:CENTRAL CAROLINA ENT ASSOCIATES
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5070
Mailing Address - Country:US
Mailing Address - Phone:919-774-6829
Mailing Address - Fax:919-775-2327
Practice Address - Street 1:1915 K M WICKER MEMORIAL DR
Practice Address - Street 2:CENTRAL CAROLINA ENT ASSOCIATES
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5070
Practice Address - Country:US
Practice Address - Phone:919-774-6829
Practice Address - Fax:919-775-2327
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC588237700000X
NC2126231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126OtherAUDIOLOGIST LICENSE #
NC890107WMedicaid
NC3404108OtherMEDICAID HEARING AID VENDOR