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General NPI Number Information
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NPI Number | 1386744597
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Entity Type | Individual
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Provider Name | MARTHA E WILSON MA
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12607 SE MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98684-6055
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Country | US
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Telephone | 360-418-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 HUNTER CT
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City | WEST LINN
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State | OR
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Zip | 97068-2276
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Country | US
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Telephone | 503-650-9678
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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 | LH00006550
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License Number State | WA
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