Provider Information for 1295203016
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PRISCILLA J WILSON LPCC
Other Names:Former Name:PRISCILLA J WILSONSex: Female
NPI: 1295203016
Last Updated: 2019-03-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1295203016 | ||||||||
| Enumeration Date | 2018-11-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 303 21ST ST STE 232 NEWPORT, MN 55055-1182 United States Phone: 763-273-0671 | Fax: | ||||||||
| Primary Practice Address | 6268 BOONE AVE N BROOKLYN PARK, MN 55428-2729 United States Phone: 651-560-0050 | Fax:651-925-0257 | ||||||||
| Secondary Practice Address(es) | 7040 LAKELAND AVE N 303 21ST ST STE 232 | ||||||||
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