Healthcare Provider Details

I. General information

NPI: 1801661665
Provider Name (Legal Business Name): AEREYON WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W ASHLAN AVE STE 100
CLOVIS CA
93612-5627
US

IV. Provider business mailing address

7531 N 1ST ST APT 205
FRESNO CA
93720-0990
US

V. Phone/Fax

Practice location:
  • Phone: 559-473-1770
  • Fax:
Mailing address:
  • Phone: 760-812-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: