Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | LT-0500.8000-200 | WI |
NPI | 1184296139 |
---|---|
Provider Name | Alyson Wilson |
First Address | Oconomowoc, WI 53066-9013 |
Second Address | Oconomowoc, WI 53066-9013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2021 |
Last Update Date | 10/07/2021 |