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General NPI Number Information
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NPI Number | 1326934076
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Entity Type | Individual
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Provider Name | ZACHARY DOUGLAS WILSON
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Gender | Male
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 3636 WESTOWN PKWY STE 204
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City | WEST DES MOINES
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State | IA
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Zip | 50266-6713
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Country | US
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Telephone | 515-505-1666
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Fax |
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Provider Business Mailing Address
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Address Line | 228 MILLER AVE
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City | DES MOINES
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State | IA
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Zip | 50315-7624
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Country | US
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Telephone | 563-379-6909
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 130458
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License Number State | IA
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