Individual
KELLY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 JONES ST STE 108, DUBUQUE, IA 52001-7615
(563) 265-8694
Mailing address
820 LAUREL ST, DUBUQUE, IA 52003-7947
(563) 663-7445
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
123862
IA
Other
Enumeration date
12/01/2023
Last updated
01/03/2024
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