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General NPI Number Information
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NPI Number | 1609727759
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Entity Type | Individual
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Provider Name | STEPHANIE ANN WILSON CMA
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Gender | Female
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 2025 GUADALUPE ST STE 260
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City | AUSTIN
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State | TX
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Zip | 78705-5642
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Country | US
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Telephone | 917-382-0243
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Fax | 315-273-6048
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Provider Business Mailing Address
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Address Line | 20119 TIMBERNOOK PASS
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City | NEW CANEY
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State | TX
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Zip | 77357-1119
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Country | US
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Telephone | 832-857-5000
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 1417630401
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License Number State | TX
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