Organization
JACQUELINE S. WILSON, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE S. WILSON M.D. (PRESIDENT)
(406) 586-7515
Entity
Organization
Contact information
Practice address
321 E MAIN ST, SUITE 309, BOZEMAN, MT 59715-6241
(406) 586-7515
(406) 522-0481
Mailing address
321 E MAIN ST, SUITE 309, BOZEMAN, MT 59715-6241
(406) 586-7515
(406) 522-0481
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
8315
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0152425
—
MT
01
—
93296
BCBS
MT
Enumeration date
09/20/2006
Last updated
03/17/2008
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