Individual
MS. MAXINE E WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 SCUPPO RD, UNIT1001, DANBURY, CT 06811-5303
(203) 826-7713
(203) 826-7713
Mailing address
15 SCUPPO RD, UNIT 1001, DANBURY, CT 06811-5303
(203) 826-7713
(203) 826-7713
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
657894
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
657894
SPECIAL EDUCATION
NY
Enumeration date
09/22/2013
Last updated
09/22/2013
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