Individual
MRS. DIANNE MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHU-HS
Contact information
Practice address
1617 E MILHAM AVER, SUITE B, PORTAGE, MI 49002
(269) 303-5931
Mailing address
1044 BIDWELL RD, QUINCY, MI 49082-9412
(231) 557-9348
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
12/20/2006
Last updated
01/13/2017
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