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NPI Code Detail

MEDICARE: COURTNEY PAIGE WILSON

MEDICARE: COURTNEY PAIGE WILSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorCG61684987WA

General Provider Information

NPI Number : 1205620713
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY PAIGE WILSON
Provider Business Mailing Address
First Line : PO BOX 2394
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8455
Country : US
Telephone Number : 360-703-2107
Fax Number :
Provider Business Practice Location Address
First Line : 1126 S GOLD ST
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-3714
Country : US
Telephone Number : 360-807-4929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2025
Last Update Date : 08/20/2025

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Directions to “ COURTNEY PAIGE WILSON ” Practice Location

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