Healthcare Provider Details

I. General information

NPI: 1245723493
Provider Name (Legal Business Name): BENJAMIN JOSEPH ROBERT WILSON CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 OKANOGAN AVE
WENATCHEE WA
98801
US

IV. Provider business mailing address

327 OKANOGAN AVE
WENATCHEE WA
98801
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-9673
  • Fax: 509-662-9441
Mailing address:
  • Phone: 509-662-9673
  • Fax: 509-662-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.60285822
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: