Individual
DR. WILSON ELIJAH ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
1025 N COUNTRY CLUB DR, MESA, AZ 85201-3307
(480) 472-1813
Mailing address
2544 E EVERGREEN ST, MESA, AZ 85213-6012
(480) 827-2111
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
588395
—
AZ
Enumeration date
03/28/2007
Last updated
07/08/2007
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