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NPI Code Detail

MEDICARE: PAULA WILSON

MEDICARE: PAULA 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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1750850046
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA WILSON
Provider Business Mailing Address
First Line : 1616 S GOLD ST
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-8930
Country : US
Telephone Number : 360-623-9419
Fax Number :
Provider Business Practice Location Address
First Line : 1616 S GOLD ST
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-8930
Country : US
Telephone Number : 360-623-9419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2018
Last Update Date : 09/11/2024

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Directions to “ PAULA WILSON ” Practice Location

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