Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Glenn Gordon Wilson, CPCCO, BOCP

Individual provider Prosthetist · NPI 1417471426

Mr. Glenn Gordon Wilson, CPCCO, BOCP is a Prosthetist in Spokane, Washington. Practices as a sole proprietor. Licensed in Washington.

Licensed in
WA
In the registry since
2017
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Practice location Address checks out

514 S Washington St
Spokane, WA 99204-2620
Phone: (509) 624-3314
Fax: (509) 787-0952
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Prosthetist (primary) Taxonomy 224P00000X · Licence PS60602304 (WA)

Record details

NPI number1417471426
Entity typeIndividual (Type 1)
GenderMale
Credentials CPCCO , BOCP
Sole proprietorYes
NPI enumeratedAugust 1, 2017
Last updated in NPPESAugust 1, 2017

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