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General NPI Number Information
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NPI Number | 1720405343
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Entity Type | Individual
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Provider Name | CHERYL WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 9300 NE OAK VIEW DR SUITE B
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City | VANCOUVER
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State | WA
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Zip | 98662-6192
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Country | US
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Telephone | 360-567-2211
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Fax | 360-567-2212
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Provider Business Mailing Address
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Address Line | 9608 NE 132ND AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-2912
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Country | US
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Telephone | 360-904-8540
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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 | LH60764006
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License Number State | WA
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