Individual
STEPHANIE WIELGOSZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5422 CLINTON BLVD, JACKSON, MS 39209-3050
(601) 724-5040
Mailing address
5422 CLINTON BLVD, JACKSON, MS 39209-3050
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P-0543
MS
Other
Enumeration date
02/23/2023
Last updated
02/23/2023
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