Individual
JOHNATHON MITT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S.W
Contact information
Practice address
781 36TH ST SE, GRAND RAPIDS, MI 49548-2319
(734) 395-8652
(616) 243-2302
Mailing address
PO BOX 141, GRAND RAPIDS, MI 49501-0141
(734) 395-8652
(616) 243-2302
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/03/2013
Last updated
04/03/2013
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