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1235515776
JEFF WILSON
SHELTON, WA
NPI
1235515776
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA CP60391036)
Enumeration Date
2015-08-06
Last Update Date
2015-08-06
Business Address
-- JEFF WILSON CDP
611 W COTA ST
SHELTON, WA 98584-2241
Phone number: 360-426-5654
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Mailing Address
-- JEFF WILSON CDP
611 W COTA ST
SHELTON, WA 98584-2241
Phone number: 360-426-5654
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