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General NPI Number Information
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NPI Number | 1023989613
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Entity Type | Individual
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Provider Name | JENNALEE WILSON LAC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 8686 E SAN ALBERTO STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4380
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Country | US
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Telephone | 602-550-0175
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Fax |
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Provider Business Mailing Address
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Address Line | 5335 W BECK LN
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City | GLENDALE
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State | AZ
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Zip | 85306-2501
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Country | US
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Telephone | 623-332-6682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-23735
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License Number State | AZ
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