Individual
DEQUAN SHAON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
827 N 6TH AVE W, VIRGINIA, MN 55792
(952) 767-4200
(952) 767-4211
Mailing address
5860 BAKER RD, MINNETONKA, MN 55345
(952) 767-4200
(952) 767-4211
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/09/2025
Last updated
10/09/2025
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