MEDICARE: MRS. ROXANNE FRANKLIN WILSON BA, QMHA, PSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	THW2008	OR
2	133NN1002X	Nutrition Education Nutritionist
3	171M00000X	Case Manager/Care Coordinator	THW2008	OR
4	174H00000X	Health Educator
5	172A00000X	Driver
6	1744R1102X	Research Study Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	THW2008	OTHER	OR	OHA THW REGISTRY NUMBER

General Provider Information

NPI Number	:	1427692623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROXANNE FRANKLIN WILSON BA, QMHA, PSS

Provider Business Mailing Address
First Line	:	650 NE 2ND ST UNIT 133
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-4762
Country	:	US
Telephone Number	:	503-472-4511
Fax Number	:	503-714-6306

Provider Business Practice Location Address
First Line	:	1900 NE HIGHWAY 99W STE K
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-2757
Country	:	US
Telephone Number	:	503-472-4511
Fax Number	:	503-714-6306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	03/28/2020

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Directions to “ MRS. ROXANNE FRANKLIN WILSON BA, QMHA, PSS” Practice Location

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