Individual
JENNIFER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2230 COMO AVE, SAINT PAUL, MN 55108-1720
(651) 635-0095
Mailing address
1605 EUSTIS ST, SAINT PAUL, MN 55108-1219
(651) 646-6393
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11006
MN
Other
Enumeration date
07/10/2008
Last updated
05/05/2009
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