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General NPI Number Information
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NPI Number | 1922230663
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Entity Type | Individual
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Provider Name | HEIDI L WILSON LPC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 715 STATE ROAD 79 SUITE B
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City | BOYCEVILLE
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State | WI
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Zip | 54725-7535
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Country | US
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Telephone | 715-643-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 715 STATE ROAD 79 SUITE B
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City | BOYCEVILLE
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State | WI
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Zip | 54725-7535
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Country | US
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Telephone | 715-643-2445
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4296-125
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License Number State | WI
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