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General NPI Number Information
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NPI Number | 1477002152
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Entity Type | Organization
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Legal Business Name | WILSON CONSULTING, LLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 110 FULTON DR
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City | VENETIA
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State | PA
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Zip | 15367-1031
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Country | US
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Telephone | 724-941-8068
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Fax |
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Provider Business Mailing Address
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Address Line | 110 FULTON DR
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City | VENETIA
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State | PA
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Zip | 15367-1013
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Country | US
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Telephone | 724-941-8068
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. RACHEL ANNE WILSON
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Credential | LSW
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Telephone | 724-941-8068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | SW010689L
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License Number State | PA
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