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1972717205
JACQUELINE ELLEN WILSON
WATERLOO, IL
NPI
1972717205
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2007-05-09
Last Update Date
2007-07-08
Business Address
-- JACQUELINE ELLEN WILSON MAQMHP
988 N ILLINOIS ROUTE 3
WATERLOO, IL 62298-1000
Phone number: 618-939-4444
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Mailing Address
-- JACQUELINE ELLEN WILSON MAQMHP
17 W WATERS EDGE DR
BELLEVILLE, IL 62221-7801
Phone number: 618-789-7385
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