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NPI Code Detail

MEDICARE: TEAL WILSON

MEDICARE: TEAL WILSON
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
1103K00000XBehavior AnalystBA-779HI

General Provider Information

NPI Number : 1538779467
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEAL WILSON
Provider Business Mailing Address
First Line : 9912 LAVENDER LN
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-1531
Country : US
Telephone Number : 785-370-6460
Fax Number :
Provider Business Practice Location Address
First Line : 9912 LAVENDER LN
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-1531
Country : US
Telephone Number : 785-370-6460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2020
Last Update Date : 06/02/2025

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Directions to “ TEAL WILSON ” Practice Location

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