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General NPI Number Information
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NPI Number | 1942961438
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Entity Type | Individual
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Provider Name | GABRIELL E WILSON ASW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 7707 AUSTIN RD
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City | STOCKTON
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State | CA
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Zip | 95215-8312
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Country | US
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Telephone | 209-467-3908
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Fax |
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Provider Business Mailing Address
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Address Line | 3308 RIVERTON WAY
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City | STOCKTON
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State | CA
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Zip | 95219-3136
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Country | US
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Telephone | 510-717-5922
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 105674
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License Number State | CA
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