Healthcare Provider Details

I. General information

NPI: 1194449108
Provider Name (Legal Business Name): IRIS WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N 7TH ST
STEUBENVILLE OH
43952-2249
US

IV. Provider business mailing address

519 XENIA AVE
DAYTON OH
45410-1823
US

V. Phone/Fax

Practice location:
  • Phone: 866-285-3408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: