Individual
KRISTEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
1985 SAGINAW ST S, SALEM, OR 97302-5235
(503) 508-7518
Mailing address
1985 SAGINAW ST S, SALEM, OR 97302-5235
(503) 508-7518
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
08-06-79
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08-06-79
ADDICTION COUNSELOR CERTIFICATION BOARD OF OREGON
OR
Enumeration date
11/13/2008
Last updated
05/10/2013
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