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1114286648
JACOB W. WILSON
NAMPA, ID
NPI
1114286648
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: ID LCSW30132)
Enumeration Date
2012-05-03
Last Update Date
2023-07-12
Business Address
JACOB W. WILSON LCSW
824 S DIAMOND ST
NAMPA, ID 83686-5960
Phone number: 208-812-4999
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Mailing Address
JACOB W. WILSON LCSW
PO BOX 2553
MCCALL, ID 83638-2553
Phone number: 208-630-4040
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