Individual
WESLEY MARK WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC-IT
Contact information
Practice address
10752 BEAL AVE, HAYWARD, WI 54843-6435
(715) 533-0736
Mailing address
PO BOX 1062, HAYWARD, WI 54843-1062
(715) 634-0222
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
8187-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100305836
—
WI
Enumeration date
12/18/2024
Last updated
03/27/2025
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