Individual
MR. JACOB R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
8616 NORTHERN AVE, ROCKFORD, IL 61107-5309
(815) 391-1000
Mailing address
8616 NORTHERN AVE, ROCKFORD, IL 61107-5309
(815) 391-1000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/21/2010
Last updated
07/31/2014
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