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General NPI Number Information
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NPI Number | 1508670308
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Entity Type | Organization
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Legal Business Name | WANDA WILSON, PLLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 3770 E AMITY AVE UNIT 106
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City | NAMPA
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State | ID
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Zip | 83687-1194
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Country | US
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Telephone | 208-918-4894
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Fax |
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Provider Business Mailing Address
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Address Line | 6615 S ACACIA ST
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City | BOISE
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State | ID
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Zip | 83709-6683
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Country | US
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Telephone | 208-407-3251
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | WANDA WILSON
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Credential | LCSW
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Telephone | 208-407-3251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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