Individual
HEATHER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12243 MILBURN ST, JAMAICA, NY 11413-1053
(347) 754-0811
Mailing address
12243 MILBURN ST, JAMAICA, NY 11413-1053
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0828999
NY
Other
Enumeration date
01/23/2025
Last updated
01/23/2025
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