Individual
AUSTIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
548 SE JACKSON ST, ROSEBURG, OR 97470-4983
(541) 440-3532
(541) 440-3554
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 440-3532
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/29/2020
Last updated
12/29/2020
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